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Colorado 
Revised Statutes 

2012 



Titles 25-28 

Health 

Health Care Policy and Financing 

Human Services Code 

Behavioral Health 
Military and Veterans 

♦ ♦♦ 

Edited, Collated, Revised, 

Annotated, and Indexed 

Under the Supervision and Direction of the 

COMMITTEE ON LEGAL SERVICES 

by 

JENNIFER G. GILROY OF THE COLORADO BAR, 

REVISOR OF STATUTES, 

AND THE 

OFFICE OF LEGISLATIVE LEGAL SERVICES 

Published with Annotations through 272 R3d 1196, 797 F Supp. 2d 1163, 661 F3d 1290, 
132 S. Ct 1882, 449 B.R. 119, 83 U. Colo. L. Rev. 338 (2011), 88 Denv. U.L. Rev. 629 
(2011), and 41 Colo. Law. 91 (January 2012). (See Annotation Explanation on page ix.) 



Reenacted by the General Assembly as the 

Positive Statutory Law of Colorado of a General and Permanent Nature 

and as the Official Statutes of the State of Colorado 

LexisNexis 

Printers and Distributors 



CONTENT OF 2012 
COLORADO REVISED STATUTES 

Declaration of Independence 

Constitution of the United States 

Enabling Act of Colorado 

Constitution of the State of Colorado 



Title 1. 


Elections 


Title 25. 


Health 


Title 2. 


Legislative 


Title 25.5. 


Health Care Policy and 


Title 3. 


United States 




Financing 


Title 4. 


Uniform Commercial Code 


Title 26. 


Human Services Code 


Title 5. 


Consumer Credit Code 


Title 27. 


Behavioral Health 


Title 6. 


Consumer and Commercial 


Title 28. 


Military and Veterans 




Affairs 


Title 29. 


Government — Local 


Title 7. 


Corporations and Associations 


Title 30. 


Government — County 


Title 8. 


Labor and Industry 


Title 31. 


Government — Municipal 


Title 9. 


Safety — Industrial and 


Title 32. 


Special Districts 




Commercial 


Title 33. 


Parks and Wildlife 


Title 10. 


Insurance 


Title 34. 


Mineral Resources 


Title 11. 


Financial Institutions 


Title 35. 


Agriculture 


Title 12. 


Professions and Occupations 


Title 36. 


Natural Resources — General 


Title 13. 


Courts and Court Procedure 


Title 37. 


Water and Irrigation 


Title 14. 


Domestic Matters 


Title 38. 


Property — Real and Personal 


Title 15. 


Probate, Trusts, and Fiduciaries 


Title 39. 


Taxation 


Title 16. 


Criminal Proceedings 


Title 40. 


Utilities 


Title 17. 


Corrections 


Title 41. 


Aeronautics: Aircraft and 


Title 18. 


Criminal Code 




Airports 


Title 19. 


Children's Code 


Title 42. 


Vehicles and Traffic 


Title 20. 


District Attorneys 


Title 43. 


Transportation 


Title 21. 


State Public Defender 


Colorado Court Rules 


Title 22. 


Education 


A — Z Index — Comparative Tables 


Title 23. 


Postsecondary Education 






Title 24. 


Government — State 







Copyright © 2012 

BY THE COMMITTEE ON LEGAL SERVICES 

FOR THE STATE OF COLORADO 



CERTIFICATION 

OF 

COMMITTEE ON LEGAL SERVICES 

The Committee on Legal Services hereby certifies that the 2012 Colorado Revised Statutes 
includes all the laws of a general and permanent nature of the state of Colorado as revised 
and reenacted in Colorado Revised Statutes 1973, together with all of the laws of a general 
and permanent nature enacted by the General Assembly subsequent to 1973, as corrected, 
collated, and revised as authorized by and in conformity with Article 5 of Title 2, Colorado 
Revised Statutes. 



COMMITTEE ON LEGAL SERVICES: 
Bob Gardner 



Member of the House of Representatives 
Chair 



John Morse 



Member of the Senate 
Vice-Chair 

Jeanne Labuda 



Member of the House of Representatives 


Claire Levy 


Member of the House of Representatives 


Carole Murray 


Member of the House of Representatives 


Mark Waller 


Member of the House of Representatives 


Greg Brophy 


Member of the Senate 


Morgan Carroll 


Member of the Senate 


Ellen Roberts 


Member of the Senate 


Gail Schwartz 



Member of the Senate 



m 



OFFICE OF LEGISLATIVE LEGAL SERVICES 

Capitol Room 091 Phone: (303) 866-2045 



DIRECTOR 
Dan L. Cartin 



DEPUTY DIRECTOR 
Sharon L. Eubanks 



REVISOR OF STATUTES 
Jennifer G. Gilroy 



ASSISTANT DIRECTORS 
Bart W. Miller, Deborah F. Haskins, Julie Pelegrin 



ADMINISTRATION TEAM 



Matthew Dawkins, Office Manager 
Wade Harrell, Office Systems Administrator 
Patti Dahlberg, Front Office Coordinator and 
Senior Legislative Assistant III 



Linda Harris, Senior Legislative Assistant II 

for Human Resources 
Robert Garcia, Senior Legislative Assistant 



BUSINESS, HEALTH CARE, NATURAL RESOURCES, AND ENVIRONMENT TEAM 



Duane H. Gall, Senior Attorney & 

Team Leader 
Christine B. Chase, Senior Attorney & 

Assistant Team Leader 
Thomas Morris, Senior Attorney & 

Assistant Team Leader 
Kristen J. Forrestal, Senior Attorney 
Charles Brackney, Senior Staff Attorney II 

for Rule Review 



Jery Payne, Senior Staff Attorney II 
Jennifer Berman, Staff Attorney 
Rebecca L. Hausmann, Head and Senior 

Legislative Assistant IV 
Patty Amundson, Senior Legislative Assistant IV 
Holly Mandis, Senior Legislative Assistant 
Kiki Miller, Legislative Assistant 



CIVIL AND CRIMINAL LAW, EDUCATION, AND HUMAN SERVICES TEAM 



Jeremiah B. Barry, Senior Attorney & Team 

Leader 
Michael Dohr, Senior Staff Attorney & 

Assistant Team Leader 
Brita Darling, Senior Staff Attorney 



Jane M. Ritter, Senior Staff Attorney 
Richard Sweetman, Senior Staff Attorney 
Beth Treat, Senior Legislative Assistant 
Joel Moore, Legislative Assistant II 
Lara Margelofsky, Legislative Assistant 



FISCAL POLICY, INFRASTRUCTURE, ELECTIONS, 
EDUCATION FINANCE, AND STATE & LOCAL GOVERNMENT TEAM 



Gregg W. Eraser, Senior Attorney & Team 

Leader 
Jason Gelender, Senior Attorney & 

Assistant Team Leader 
Robert S. Lackner, Senior Attorney & 

Assistant Team Leader 
Edward DeCecco, Senior Attorney 
Esther van Mourik, Senior Staff Attorney II 



Nicole Myers, Senior Staff Attorney II 

Kate Meyer, Senior Staff Attorney 

Effie Ameen, Head and Senior Legislative 

Assistant III 
John Kilgour, Senior Legislative Assistant 
Ashley Zimmerman, Senior Legislative Assistant 
Cara Meeker, Legislative Assistant 



PUBLICATIONS TEAM 



Kathryn S. Zambrano, Publications Coordinator 
Michele D. Brown, Senior Staff Attorney II 

for Annotations 
Anja H. Boyd, Assistant Publications 

Coordinator & Senior Legislative Assistant IV 



Peggy Lewis, Senior Legislative Assistant IV 
Carol L. Mullins, Senior Legislative Assistant III 
Nathan M. Carr, Senior Legislative Assistant II 
to the Revisor of Statutes 



IV 



TABLE OF CONTENTS 



Source note explanation vi 

Colorado statutory research vii 

Bills without safety clauses - explanation of effective dates ix 

Annotation explanation ix 

Title 25 Health Title 25 - page 1 

Title 25.5 Health Care Policy and Financing Title 25.5 - page 1 

Title 26 Human Services Code Title 26 - page 1 

Title 27 Behavioral Health Title 27 - page 1 

Title 28 Military and Veterans Title 28 - page 1 



Source Note Information 



A source note shows the legislative history of a C.R.S. section and is located immediately 
after the text of the section. The source note for each section indicates the year the section 
was added, each year it was amended, and the page of the Session Laws and the section of 
the bill where the amendment can be found. The source note includes the number of the 
section in prior codifications when applicable. For amendments made after 1973, informa- 
tion on each specific provision of the section that has been changed by a bill, the specific 
change to the provision (i.e. added, added with relocations, amended, amended with 
relocations, repealed, repealed and reenacted, or recreated and reenacted), and the effective 
date of the bill are shown. 

The legislative history is arranged by year of passage; if the section was amended by two 
or more acts in the same year, the order of the information for that year is determined by 
the effective dates of the acts. The effective date in the source note indicates the date the act 
or portion of the act takes effect even if the text of the amendment indicates a different date. 
If the year is not included with the month and day, the provision is effective the year of 
passage. Additional information to assist the user in researching C.R.S. sections can be 
found beginning on page vii. 

The following provides a further explanation of the information found in a source note: 

"L." is the symbol for "Session Laws" and will be followed by a number 
indicating the year when the C.R.S. section was changed by an act generally 
either creating new law, amending existing law, or repealing existing law; 
except that, in the constitution, "L." also means constitutional measures 
referred by the General Assembly and voted on by the people of Colorado at 
a general or an odd-year election. 

"Ex. Sess." is the symbol for "Extraordinary Session". If this symbol 
follows the year, the amended provision can be found in the Session Laws 
for an extraordinary session for that year and not in the Session Laws for the 
regular session of the General Assembly for that year (S, S2 in the Red 
Book). 

"p." is the symbol for "page" and will be followed by a number indicating 
the page of the Session Laws where the amendment to the C.R.S. section can 
be found. 

"§" is the symbol for "section" and will be followed by a number indicating 
the section of the act where the amendment to the C.R.S. section can be 
found. 

"IP" is the symbol for the "introductory portion" to a section, subsection, 
paragraph, or subparagraph. 

"Added" means the provision was newly enacted by the act (N in the Red 
Book). 

"Added with relocations" means the provision in existing law was relocated 
from one title, article, part, or section to another title, article, part, or section 
with amendments by the act. 

vi 



"Amended" means the provision in existing law was amended by the act (A 
in the Red Book). 

"Amended with relocations" means the provision in existing law was 
amended to reorganize an entire title, article, part, or section by the act. 

"Repealed" means the provision was deleted from the existing law by the 
act through the use of a repeal provision (R in the Red Book). 

"R&RE" is the symbol for "Repealed and Reenacted" and means the 
provision in existing law was repealed and reenacted by the act (RE in the 
Red Book). 

"RC&RE" is the symbol for "Recreated and Reenacted" and means a 
previously repealed provision has been recreated by the act (RC in the Red 
Book). 

"Added by revision" means a provision providing for the repeal of a 
statutory provision on a specified date has been added by the Revisor of 
Statutes as a C.R.S. provision. Adding the provision is necessary because a 
separate section of the act provided for the repeal of the provision with a 
future effective date. 

"Initiated" means a provision that was amended by means of an initiated 
petition approved by a vote of the people of Colorado at a general or an 
odd-year election. 

"Referred" means a provision that was amended by a measure referred by 
the General Assembly and voted on by the people of Colorado at a general 
or an odd-year election; except that, in the constitution, a referred measure 
is indicated by "L." and also means constitutional measures referred by the 
General Assembly and voted on by the people of Colorado at a general or an 
odd-year election. 

Starting in 2009, references to the bill number and chapter number have been 
included in the source note. If you are conducting a search on-line, the bill 
number reference within the source note links directly to the bill itself. 

Colorado Statutory Research 

Legislative history is not already written. It must be compiled by the researcher from many 
different sources and materials. The following information is a helpful starting point in 
identifying information you wish to research. Consult the red book table distributed with the 
session laws, the softbound editions of Colorado Revised Statutes beginning in 1997, the 
comparative tables located in the back of the C.R.S. index, C.R.S. 1963 and subsequent 
cumulative supplements thereto through 1971, and C.R.S. 1973 and annual cumulative 
supplements thereto through 1996. 

Prior to 1921, enacted laws were not compiled into a comparative table, thereby making it 
more difficult to track the legislative history. Determining the subject matter in the statutory 
index is the only choice for tracking the history of a statute since a statute did not retain its 
original number. The General Statutes of 1883 arranged laws into numbered chapters, 
alphabetically entitled, collated, and arranged by sections. This became the foundation and 

vii 



model for compiling the statutes until the codification of C.R.S. 1973, (See Revised Statutes 
of Colorado 1908, An Act Providing For the Compilation, Publication, and Distribution of 
all the general statutes of the state.) 

References in some source notes throughout the Colorado Revised Statutes to "Code 08", 
"Code 21", and "Code 35" are to the Revised Statutes of Colorado 1908, the Compiled 
Laws of Colorado 1921, and the Colorado Statutes Annotated 1935, respectively. Each of 
these volumes set forth the general statutes of the state of Colorado, including the Code of 
Civil Procedure and, in 1935, the Colorado Supreme Court Rules. On January 6, 1941, the 
Colorado Supreme Court adopted the new Rules of Civil Procedure, which became 
effective on April 6, 1941, resulting in the publication of a replacement volume. Thereafter, 
the publication of the Colorado Court Rules, although a continuing part of the Colorado 
Revised Statutes, contained a combination of the Federal Rules and the Colorado Code of 
Civil Procedure and, in addition, included some provisions that were entirely distinct from 
both the Federal Rules and the Colorado Code of Civil Procedure, as adopted or amended 
by the Supreme Court of Colorado. 

To research a statute as it existed in previous years, the following is a chronological list of 
C.R.S. publications and the correct citation for each publication. 

Revised Statutes of Colorado 
General Laws of Colorado 
General Statutes of Colorado 
Revised Statutes of Colorado 
Compiled Laws of Colorado 
Colorado Statutes Annotated 
Colorado Revised Statutes 1953 
Colorado Revised Statutes 1963 
Colorado Revised Statutes 

Comparative Tables: 

R.S. 08 to C.L. 1921 - located in the front of the C.L. 1921 
C.L. 1921 to CSA 1935 - located in the back of the Index to CSA 1935 
CSA 1935 to CRS 1953 - located in the front of the Index to CRS 1953 
CRS 1953 to C.R.S. 1963 - located in the front of the Index to C.R.S. 1963 
C.R.S. 1963 to C.R.S. - located in the back of the Index to C.R.S. 

Supplements to C.R.S. 1963 include: 

1965 hardbound supplement containing laws enacted in 1964 and 1965 
1967 hardbound supplement containing laws enacted in 1966 and 1967 
1969 hardbound supplement containing laws enacted in 1968 and 1969 
1971 hardbound supplement containing laws enacted in 1970 and 1971 

The softbound publication of the "Official Report of the Committee on Legal Services" was 
not intended as an official publication of our office. Copies were distributed to the members 
of the General Assembly for the purpose of certifying the laws enacted in the 1972 and 1973 
Sessions for inclusion in the compilation of the 1973 C.R.S., which was not available until 
1974. To find the 1972 or 1973 amended language, refer to the session laws of either 1972 
or 1973. 



(1868) 


R.S. 


(1877) 


G.L. 


(1883) 


G.S. 


(1908) 


R.S. 08 


(1921) 


C.L. 


(1935) 


CSA 


(1953) 


CRS 53 


(1963) 


C.R.S. 1963 


(1973) 


C.R.S. 



Vlll 



Supplements and Replacement Volumes to C.R.S. 1973 and, on and after 1983, to 
Colorado Revised Statutes 



Titles 


Supplements to C.R.S. 

1973 and, on and after 
1983, to Colorado 
Revised Statutes 


Replacement Volumes and 

Supplements to Replacement 

Volumes 


Titles 25, 
26, 27, & 
28 


1975-81 Supplements 


1982 Replacement Volume 

1983-88 Supplements 
1989 Replacement Volume 
Vol. IIA Title 25 
1990-96 Supplements 
Vol. IIB - Titles 26-28 
1990-96 Supplements 



Starting in 1997, annual softbound volumes are published each year. 

For additional information on researching legislative history, see www.leg.state.co.us. 
Services Agencies, and select Legislative Legal Services. Choose Legal Topics and click on 
Researching Legislative History. 



Bills Enacted Without A Safety Clause 
Explanation of Effective Date 



If a bill is enacted without a safety clause and an effective date is not indicated in the bill, 
the effective date is the day following the expiration of the ninety-day period after final 
adjournment of the General Assembly that is allowed for submitting a referendum petition 
pursuant to article V, section 1 (3) of the state Constitution unless a referendum petition is 
filed against the act within such time period. If a referendum petition is filed, the act, if 
approved by the people, will take effect on the date of the official declaration of the vote 
thereon by proclamation of the Governor or the date indicated in the act if it is later than 
the Governor's proclamation. The source note for a provision contained in such an act will 
indicate the actual date following the ninety-day period or the date set out in the act. If a 
referendum petition is filed, the date in the source note will be adjusted accordingly in the 
next publication following the election where the referendum petition is considered. 



Annotations 



Beginning in 2012, the annotations for Colorado state appellate court decisions include both 
public domain and regional reporter case cites. In preparing annotations to court decisions, 
we endeavor to include the most recent decisions. Occasionally, this may result in the 
inclusion of a decision before it becomes finalized and published in an official reporter. In 
such instances, the case cite will contain blank spaces for the volume and page number of 
the reporter. The volume and page number will be substituted for the blank spaces in 
subsequent pubhcations of the statutes. 



IX 



TITLE 25 
HEALTH 



TITLE 25 

HEALTH 

ADMINISTRATION 

Art. 1. Administration, 25-1-101 to 25-1-1403. 

Art. 1.5. Powers and Duties of the Department of Public Health and Environment, 
25-1.5-101 to 25-1.5-304. 

VITAL STATISTICS 

Art. 2. Vital Statistics, 25-2-101 to 25-2-122. 

HOSPITALS 

Art. 3. Hospitals, 25-3-100.5 to 25-3-705. 

Art. 3.5. Emergency Medical and Trauma Services, 25-3.5-101 to 25-3.5-809. 

DISEASE CONTROL 

Art. 4. Disease Control, 25-4-101 to 25-4-2504. 

PRODUCTS CONTROL AND SAFETY 

Art. 5. Products Control and Safety, 25-5-101 to 25-5-1106. 
Art. 5.5. Dairy Products, Imitation Dairy Products, and Frozen Desserts, 25-5.5-101 
to 25-5.5-312. 

FAMILY PLANNING 

Art. 6. Family Planning, 25-6-101 to 25-6-302. 

ENVIRONMENTAL CONTROL 

Environmental Control, 25-6.5-101 to 25-6.5-203. 

Environmental Management System Permit Program, 25-6.6-101 to 

25-6.6-106. 
Environmental Leadership Act (Repealed). 
Air Quality Control, 25-7-101 to 25-7-1309. 
Water Quality Control, 25-8-101 to 25-8-803. 

Cherry Creek Basin Water Quality Authority, 25-8.5-101 to 25-8.5-120. 
Water and Wastewater Treatment Plant Operators, 25-9-101 to 25-9-110. 
On-site Wastewater Treatment Systems Act, 25-10-101 to 25-10-113. 
Radiation Control, 25-11-101 to 25-11-305. 
Noise Abatement, 25-12-101 to 25-12-110. 
Recreation Land Preservation, 25-13-101 to 25-13-114. 
Control of Smoking, 25-14-101 to 25-14-301. 
Hazardous Waste, 25-15-101 to 25-15-515. 
Hazardous Waste Sites, 25-16-101 to 25-16-311. 
Pollution Prevention, 25-16.5-101 to 25-16.5-110. 
Waste Diversion and Recycling, 25-17-101 to 25-17-308. 
Underground Storage Tanks (Repealed). 
Illegal Drug Laboratories, 25-18.5-101 to 25-18.5-105. 
Industrial Hemp Remediation Pilot Program, 25-18.7-101 to 25-18.7-105. 

Title 25 - page 3 



Art. 


6.5, 


Art. 


6.6, 


Art. 


6.7, 


Art. 


7. 


Art. 


8. 


Art. 


8.5, 


Art. 


9. 


Art. 


10. 


Art. 


11. 


Art. 


12. 


Art. 


13. 


Art. 


14. 


Art. 


15. 


Art. 


16. 


Art. 


16.5 


Art. 


17. 


Art. 


18. 


Art. 


18.5 


Art. 


18.7 



Health Title 25 - page 4 

ENVIRONMENT - SMALL COMMUNITIES 

Art. 19. Small Community Environmental Flexibility Act, 25-19-101 to 25-19-108. 

SAFETY - DISABLED PERSONS 

Art. 20. Duties Owed Disabled Persons - Identification, 25-20-101 to 25-20-108. 

PREVENTION, INTERVENTION, AND TREATMENT SERVICES 

Art. 20.5. Prevention, Intervention, and Treatment Services for Children and Youth, 
25-20.5-101 to 25-20.5-706. 

HEALTH CARE 

Dental Care, 25-21-101 to 25-21-108. 

Children's Dental Assistance and Fluoridation Program, 25-21.5-101 to 

25-21.5-109. 
State Loan Repayment Program (Repealed). 
Dental Loan Repayment Program, 25-23-101 to 25-23-105. 
Colorado Health Facihties Authority, 25-25-101 to 25-25-131. 
Multiphasic Health Screening, 25-26-101 to 25-26-104. 
Assisted Living Residences, 25-27-101 to 25-27-113. 
Home Care Agencies, 25-27.5-101 to 25-27.5-110. 
Colorado Health Data Commission (Repealed). 
Denver Health and Hospital Authority, 25-29-101 to 25-29-126. 
Female Genital Mutilation Outreach (Repealed). 
Colorado Nurse Home Visitor Program, 25-31-101 to 25-31-108. . 
Poison Control Act, 25-32-101 to 25-32-106. 
Farmers' Market Nutrition Program Women, Infants, and Children 

(Repealed). 
Colorado Stroke Advisory Board (Repealed). 
Stroke Prevention and Treatment Cash Fund Transfer, 25-34.1-101. 
Colorado Cancer Drug Repository Program, 25-35-101 to 25-35-105. 
Short-term Grants for Innovative Health Programs, 25-36-101. 
Contracts With Health Care Providers, 25-37-101 to 25-37-116. 
Physician Designation and Disclosure, 25-38-101 to 25-38-108. 
Colorado Alzheimer's Coordinating Council (Repealed). 
Umbilical Cord Blood Collection and Awareness, 25-40-101 to 25-40-104. 
Restroom Access Act, 25-41-101. 
Taxing Authority of Unit of Government Hospital Care Providers, 25-42-101 

to 25-42-107. 
Required Head Trauma Guidehnes, 25-43-101 to 25-43-103. 

ADMINISTRATION 

ARTICLE 1 
Administration 

PARTI 25-1-102. Department created - executive 

director - divisions. 

DEPARTMENT OF PUBLIC HEALTH AND 25- 1 - 1 03. State board of health created. 

ENVIRONMENT 25-1-104. State board - organization. 

25- 1 - 1 05. Executive director - chief med- 
25-1-101. Construction of terms. ical officer - qualifications - 

25-1-101.5. Authority of revisor of statutes salary - office. 

to amend references to de- 25-1-106. Division personnel, 

partment - affected statutory 25-1-107. Powers and duties of the de- 
provisions, partment - repeal. (Repealed) 



Art. 


21. 


Art. 


21.5 


Art. 


22. 


Art. 


23. 


Art. 


25. 


Art. 


26. 


Art. 


27. 


Art. 


27.5 


Art. 


28. 


Art. 


29. 


Art. 


30. 


Art. 


31. 


Art. 


32. 


Art. 


33. 


Art. 


34. 


Art. 


34.1 


Art. 


35. 


Art. 


36. 


Art. 


37. 


Art. 


38. 


Art. 


39. 


Art. 


40. 


Art. 


41. 


Art. 


42. 


Art. 


43. 



Title 25 - page 5 



Administration 



25-1-107.5. Additional authority of depart- 
ment - rules - remedies 
against nursing facilities - 25-1-123. 
criteria for recommending 
assessments for civil penal- 
ties - cooperation with de- 
partment of health care pol- 25-1-124. 
icy and financing - nursing 
home penalty cash fund - ac- 
countability board - reports - 25-1-124.5. 
repeal. 

25-1-108. Powers and duties of state 

board of health. 25-1-125. 

25-1-108.5. Additional powers and duties 
of state board of health and 
department - programs that 25-1-126. 
receive tobacco settlement 
moneys - monitoring - annual 
report. 

25-1-108.7. Health care credentials uniform 
application act - legislative 
declaration - definitions - 25-1-127. 
state board of health rules. 

25-1-109. Powers and duties of division 

of administration. 

25-1-110. Higher standards permissible. 

25- 1 - 1 1 1 . Revenues of department. 

25-1-112. Legal adviser - actions. 

25-1-113. Judicial review of decisions. 

25-1-114. Unlawful acts - penalties. 

25-1-114.1. Civil remedies and penalties. 

25-1-114.5. Voluntary disclosure arising 
from self-evaluation - pre- 
sumption against imposition 
of administrative or civil 
penalties. 

25-1-114.6. Implementation of environ- 
mental self-audit law - pilot 
project - legislative declara- 
tion. 

25-1-115. Treatment - religious belief. 

25-1-116. Licensed healing systems not 

affected. 

25-1-117. Acquisition of federal surplus 

property. 

25-1-118. Rental properties - salvage - 

fund created - repeal. (Re- 
pealed) 

25- 1-119. Disposition and expenditures of 

moneys from fund. (Re- 
pealed) 

25- 1 - 1 20. Nursing facilities - rights of pa- 

tients. 

25-1-121. Patient grievance mechanism - 

institution's obligations to 
patient. 

25- 1 - 1 22. Named reporting of certain dis- 

eases and conditions - access 
to medical records - confi- 25-1-501. 
dentiality of reports and re- 25-1-502. 
cords. 25-1-503. 

25-1-122.5. Confidentiality of genetic test- 



ing records - "Uniform Par- 
entage Act". 

Restructure of health and hu- 
man services - development 
of plan - participation of de- 
partment required. 

Health care facilities - con- 
sumer information - report- 
ing - release. 

Nursing care facilities - em- 
ployees - criminal history 
check. 

Applications for licenses - au- 
thority to suspend licenses - 
rules. 

County practitioner rural re- 
cruitment grant program - 
creation - legislative declara- 
tion - administration - report 

- definitions - repeal. (Re- 
pealed) 

Medical equipment for rural 
communities grant program - 
creation - legislative declara- 
tion - administration - report 

- repeal. (Repealed) 

PART 2 



ALCOHOL AND DRUG ABUSE 



25-1-201 to 
25-1-217. 



(Repealed) 
PART 3 



ALCOHOLISM AND INTOXICATION 
TREATMENT 



25-1-301 to 
25-1-316. 



25-1-401. 
25-1-402. 
25-1-403. 
25-1-404. 



(Repealed) 

PART 4 

STATE CHEMIST 

Office of state chemist created. 
Employment of assistants. 
Analyses of food and drugs. 
Certificate presumptive evi- 
dence. 

PART 5 

PUBLIC HEALTH 

SUBPART 1 

GENERAL 

Legislative declaration. 
Definitions. 

State board - public health du- 
ties. 



Health 



Title 25 - page 6 



SUBPART 2 
PUBLIC HEALTH PLANS 

25-1-504. Comprehensive public health 

plan - development - ap- 
proval - reassessment - cash 
fund. 

25-1-505. County and district public 

health plans - approval. 

SUBPART 3 

COUNTY OR DISTRICT PUBLIC HEALTH 
AGENCIES 

25-1-506. County or district public health 

agency. 
25-1-507. Municipal board of health. 

25-1-508. County or district boards of 

public health - public health 

directors. 
25-1-509. County and district public 

health directors. 
25-1-510. County or district board unable 

or unwilling to act. 
25-1-511. County treasurer - agency 

funds. 
25-1-512. Allocation of moneys - public 

health services support fund - 

created. 
25-1-513. Enlargement of or withdrawal 

from public health agency. 
25-1-514. Legal actions - legal adviser. 

25-1-515. Judicial review of decisions. 

25-1-516. Unlawful acts - penalties. 

25-1-517. Mode of treatment inconsistent 

with religious creed or tenet. 
25-1-518. Nuisances. 

25-1-519. Existing intergovernmental 

agreements. 
25-1-520. Clean syringe exchange pro- 

grams - approval - reporting 

requirements - repeal. 

PART 6 

LOCAL BOARDS OF HEALTH 

25-1-601 to 

25-1-667. (Repealed) 

PART 7 

REGIONAL HEALTH DEPARTMENTS 



25-1-701 to 
25-1-719. 



25-1-801 



(Repealed) 

PART 8 

PATIENT RECORDS 

Patient records in custody of 
health care facility. 



25-1-802. Patient records in custody of 

individual health care provid- 
ers. 

25-1-803. Effect of this part 8 on similar 

rights of a patient. 

PART 9 

ADVISORY COMMISSION ON FAMILY 
MEDICINE 



25-1-901. 


Legislative declaration. 


25-1-902. 


Commission created - compo- 




sition - terms of office. 


25-1-903. 


Duties of commission. 


25-1-904. 


Sunset review. (Repealed) 




PART 10 



CHILD CARE PROGRAMS IN 
NURSING HOME FACILITIES 



25-1-1001. 
25-1-1002. 
25-1-1003. 



25-1-1004. 



Legislative declaration. 

Definitions. 

Grant program - requirements - 

use of medical assistance 

funds prohibited. 
Study of statutes and rules and 

regulations pertaining to 

nursing home facilities and 

day care centers. 

PART 11 



DRUG ABUSE PREVENTION, 
EDUCATION, AND TREATMENT 

25-1-1100.2 to 
25-1-1112. (Repealed) 

PART 12 

MEDICAL RECORD CONFIDENTIALITY 

25-1-1201. Legislative declaration. 

25-1-1202. Index of statutory sections re- 

garding medical record con- 
fidentiality and health infor- 
mation. 

25-1-1203. Electronic storage of medical 

records. 

25-1-1204. On-line exchange of advanced 

directives forms permitted. 

PART 13 

CLIMATE CHANGE MARKETS GRANT 
PROGRAM 

25-1-1301. Short title. 

25-1-1302. Legislative declaration. 

25-1-1303. Grants for research - reports to 

general assembly. 



Title 25 - page 7 



Administration 



25-1-102 



PART 14 

HEALTH INFORMATION TECHNOLOGY 

25-1-1401 to 

25-1-1403. (Repealed) 

PART 1 
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 

25-1-101. Construction of terms. (1) When any law of this state refers to the 
executive director of the state department of public health or of the department of health, 
said law shall be construed as referring to the executive director of the department of public 
health and environment. 

(2) Whenever any law of this state refers to the state department of public health or to 
the department of health, said law shall be construed as referring to the department of public 
health and environment. 

Source: L. 68: p. 106, § 73. C.R.S. 1963: § 66-1-1. L. 93: Entire section amended, p. 
1095, § 9, effective July 1, 1994. 

Cross references: For the legislative declaration contained in the 1993 act amending this section, 
see section 1 of chapter 230, Session Laws of Colorado 1993. 

ANNOTATION 



This article is a legislative declaration of 
the prevailing policy of Colorado in connection 
with the practice of medicine and the operation 
of hospitals. Moon v. Mercy Hosp., 150 Colo. 
430, 373 R2d 944 (1962). 

Overview of the state's three-tiered public 
health system and the responsibilities delegated 
under parts 5 and 6 of this article appears in 



Jefferson County Health Servs. Ass'n v. Feeney, 
974 R2d 1001 (Colo. 1998). 

County board of health, not the board of 
county commissioners, is the "governing body" 
of a county health department for purposes of 
notice under the Governmental Immunity Act. 
Jefferson County Health Servs. Ass'n v. Feeney, 
974 R2d 1001 (Colo. 1998). 



25-1-101.5. Authority of revisor of statutes to amend references to department - 
affected statutory provisions. The revisor of statutes is hereby authorized to change all 
references in the Colorado Revised Statutes to the department of health from said reference 
to the department of public health and environment, as appropriate. In connection with such 
authority, the revisor of statutes is hereby authorized to amend or delete provisions of the 
Colorado Revised Statutes so as to make the statutes consistent with the renaming of the 
department to the department of public health and environment. 

Source: L. 93: Entire section added, p. 1095, § 10, effective July 1, 1994. 

Cross references: For the legislative declaration contained in the 1993 act enacting this section, see 
section 1 of chapter 230, Session Laws of Colorado 1993. 

25-1-102. Department created - executive director - divisions. (1) There is hereby 
created a department of public health and environment, referred to in this part 1 and article 
1.5 of this title as the "department". The head of the department shall be the executive 
director of the department of public health and environment, which office is hereby created. 
The governor shall appoint said executive director, with the consent of the senate, and the 
executive director shall serve at the pleasure of the governor. The reappointment of an 
executive director after initial election of a governor shall be subject to the provisions of 
section 24-20-109, C.R.S. The executive director shall administer the department, subject 
to the authority of the state board of health, the air quality control commission, the state 
water quality control commission, and the solid and hazardous waste commission. 



25- 1 - 1 03 Health Title 25 - page 8 

(2) The department shall consist of the following divisions: 

(a) The division of administration, and such sections and units established as provided 
by law. 

(b) (Deleted by amendment, L. 93, p. 1095, § 11, effective July 1, 1994.) 

Source: L. 47: p. 505, § 2. CSA: C. 78, § 21 (2). CRS 53: § 66-1-2. C.R.S. 1963: 

§ 66-1-2. L. 68: p. 106, § 74. L. 70: p. 237, §§ 2, 4. L. 71: pp. 106, 657, §§ 16, 3. 
L. 79: (1) amended, p. 1058, § 4, effective June 20. L. 86: (1) amended, p. 888, § 18, 
effective May 23. L. 92: (1) amended, p. 1235, § 2, effective August 1. L. 93: Entire 
section amended, p. 1095, § 11, effective July 1, 1994. L. 2003: (1) amended, p. 706, 
§ 29, effective July 1. L. 2006: (1) amended, p. 1138, § 26, effective July 1. 

Cross references: For the legislative declaration contained in the 1993 act amending this section, 
see section 1 of chapter 230, Session Laws of Colorado 1993. 

25-1-103. State board of health created. ( 1 ) There is hereby created a state board of 
health, referred to in this part 1 as the "board", which shall consist of nine members, of 
which one member shall be appointed by the governor, with the consent of the senate, from 
each congressional district and the remainder from the state at large. A vacancy on the board 
occurs whenever any member moves out of the congressional district from which he was 
appointed. A member who moves out of such congressional district shall promptly notify 
the governor of the date of such move, but such notice is not a condition precedent to the 
occurrence of the vacancy. The governor shall fill the vacancy by appointment for the 
unexpired term. No more than five members of the board shall be members of the same 
major political party. Appointments made to take effect on January 1, 1983, shall be made 
in accordance with section 24-1-135, C.R.S. Appointments thereafter shall be made, with 
the consent of the senate, for terms of four years each and shall be made so that no business 
or professional group shall constitute a majority of the board. In making appointments to the 
board, the governor is encouraged to include representation by at least one member who is 
a person with a disabihty, as defined in section 24-45.5-102 (2), C.R.S., a family member 
of a person with a disability, or a member of an advocacy group for persons with 
disabilities, provided that the other requirements of this subsection (1) are met. 

(2) The first vacancy that occurs on the board after July 1, 1977, shall be filled by the 
appointment of a person who is then serving as a county commissioner. Thereafter, as 
vacancies occur and terms expire, there shall always be one county commissioner member 
on the board. Whenever a county commissioner ceases to hold the office of county 
commissioner, he ceases to hold his position as a member of the board. A county 
commissioner shall not vote on any matter coming before the board which affects his county 
in a manner significantly different from the manner in which it affects other counties. 

Source: L. 47: p. 505, § 3. CSA: C. 78, § 21 (3). CRS 53: § 66-1-3. C.R.S. 1963: 

§ 66-1-3. L. 68: p. 106, § 75. L. 72: p. 549, § 12. L. 77: Entire section amended, p. 
1257, § 1, effective July 1. L. 82: (1) amended, p. 356, § 15, effective April 30. L. 2009: 
(1) amended, (HB 09-1281), ch. 399, p. 2154, § 3, effective August 5. 

Cross references: For the transfer of the state board of health to an administrative department, see 
§ 24-1-119. 

25-1-104. State board - organization. The board shall elect from its members a 
president, a vice-president, and such other board officers as it shall determine. The executive 
director of the department, in the discretion of the board, may serve as secretary of the board 
but shall not be eligible to appointment as a member. All board officers shall hold their 
offices at the pleasure of the board. Regular meetings of the board shall be held not less than 
once every three months at such times as may be fixed by resolution of the board. Special 
meetings may be called by the president, by the executive director of the department, or by 
a majority of the members of the board at any time on three days' prior notice by mail or. 



Title 25 - page 9 Administration 25- 1 - 1 06 

in case of emergency, on twenty-four hours' notice by telephone or telegraph. The board 
shall adopt, and at any time may amend, bylaws in relation to its meetings and the 
transaction of its business. A majority shall constitute a quorum of the board. Members shall 
receive the same per diem compensation and reimbursement of expenses as those provided 
for members of boards and commissions in the division of professions and occupations 
pursuant to section 24-34-102 (13), C.R.S. All meetings of the board, in every suit and 
proceeding, shall be taken to have been duly called and regularly held, and all orders and 
proceedings of the board to have been authorized, unless the contrary is proved. 

Source: L. 47: p. 505, § 3. CSA: C. 78, § 21 (3). CRS 53: § 66-1-4. C.R.S. 1963: 
§ 66-1-4. L. 81: Entire section amended, p. 1298, § 1, effective June 9. 

25-1-105. Executive director - chief medical officer - qualifications - salary - office. 

(1) The executive director of the department shall: 

(a) Have a degree of doctor of medicine or doctor of osteopathy, be licensed to practice 
medicine in the state of Colorado, and have at least one of the following qualifications: 

(1) One year of graduate study in a school of public health; 

(II) Not less than two years' experience in an administrative capacity in a health care 
organization; 

(III) Four years of said experience when one year of graduate study in a school of 
public health has not been completed; or 

(b) Have, at a minimum, experience or education in public administration and public or 
environmental health. 

(2) (a) If the governor appoints an executive director who does not have the qualifi- 
cations specified in paragraph (a) of subsection ( 1 ) of this section, the executive director of 
the department shall, pursuant to the provisions of section 13 of article XII of the state 
constitution, upon consultation with the governor, and with the consent of a majority of the 
members of the senate, appoint a chief medical officer. The chief medical officer shall have 
the qualifications specified in paragraph (a) of subsection (1) of this section and shall serve 
at the pleasure of the governor. The executive director shall initially appoint the chief 
medical officer no later than three months after the executive director's appointment has 
been confirmed by the senate. 

(b) The chief medical officer shall provide independent medical judgment, guidance, 
and advice to the governor and to the executive director regarding medical and public health 
issues in all areas identified in article 1 .5 of this title. 

(c) The chief medical officer shall be afforded direct access to the governor and the 
governor's staff. 

(3) The executive director shall receive such salary as may be fixed by the board subject 
to the state constitution and state laws and within the limits of funds made available to the 
department by appropriation of the general assembly or otherwise. The executive director 
shall be allowed traveling and subsistence expenses actually and necessarily incurred in the 
performance of the executive director's official duties when absent from his or her place of 
residence. The executive director shall be custodian of all property and records of the 
department. 

Source: L. 47: p. 506, § 4. CSA: C. 78, § 21 (4). CRS 53: § 66-1-5. C.R.S. 1963: 
§ 66-1-5. L. 68: p. 106, § 76. L. 79: Entire section amended, p. 999, § 1, effective May 
25. L. 96: Entire section amended, p. 785, § 1, effective July 1. L. 2003: (2)(b) amended, 
p. 706, § 30, effective July 1. 

25-1-106. Division personnel. The executive director of the department shall appoint 
the director of the division of administration, pursuant to the provisions of section 1 3 of 
article XII of the state constitution. Each subdivision (and section) of the division of 
administration shall be under the management of a head, and such heads and all other 
subordinate personnel of the division shall be appointed by the director of the division, 
subject to the constitution and state personnel system laws of the state, and shall possess 



25-1-107 Health Title 25 - page 10 

qualifications approved by the board. All personnel shall receive such compensation as fixed 
by the executive director with the approval of the board, subject to the constitution and state 
personnel system laws of the state and within the limits of funds made available to the 
department by appropriation of the general assembly or otherwise. With the approval of the 
executive director, employees shall also be allowed traveling and subsistence expenses 
actually and necessarily incurred in the performance of their official duties when absent 
from their places of residence. 

Source: L. 47: p. 506, § 4. CSA: C. 78, § 21(4). CRS 53: § 66-1-6. C.R.S. 1963: 

§ 66-1-6. L. 71: p. 106, § 17. 

Cross references: For the state personnel system, see article 50 of title 24. 

25-1-107. Powers and duties of the department - repeal. (Repealed) 

Source: L. 47: p. 508, § 5. L. 49: p. 438, § 1. CSA: C. 78, § 21 (5). L. 53: p. 341, 
§ l.CRS 53: § 66-1-7. L. 55: pp. 425, 426, §§ 1, 1. L. 57: p. 413, § l.L. 59: pp. 467, 
470, §§ 1, 1. L. 62: p. 171, § 1. C.R.S. 1963: § 66-1-7. L. 64: pp. 139, 478, §§ 67, 1. 
L. 65: p. 692, § 1. L. 67: p. 345, §§ 14, 16. L. 69: pp. 467, 468, §§ 1, 1. L. 71: p. 639, 
§ 2. L. 73: pp. 893, 1405, §§ 2, 45. L. 75: (1)(1)(I) amended, p. 866, § 1, effective May 
31; (l)(m) amended, p. 868, § 1, effective May 31; (l)(o) amended, p. 869, § 1, effective 
June 26. L. 77: (l)(e) and (2) amended and (l)(x) added, p. 1259, § 1, effective June 9; 
(l)(n) amended, p. 952, § 21, effective August 1. L. 78: (3) added, p. 408, § 1, effective 
April 27; (1)(1)(I) amended, p. 440, § 2, effective May 18. L. 80: (l)(y) added, p. 649, § 2, 
effective July 1. L. 83: (l)(z) added, p. 1026, § 1, effective May 3; (l)(aa) added, p. 1027, 
§ 1, effective May 23; (1)(1)(I) amended, p. 1052, § 2, effective May 25; (l)(cc) added, p. 
1028, § 1, effective June 10; (l)(q) amended, p. 1055, § 1, effective July 1; (l)(y) R&RE 
and (l)(bb), p. 1223, §§ 2, 3, effective July 1. L. 84: (1)(1)(I) amended, p. 337, § 3, 
effective April 25. L. 85: (l)(o) R&RE, p. 901, § 2, effective April 5; (1)(1)(I) amended, 
p. 927, § 6, effective July 1; (l)(l)(II.l) added, p. 683, § 12, effective July 1; (l)(dd) added, 
p. 877, § 1, effective July 1. L. 87: IP(l)(x)(V) and (l)(x)(VI) amended, p. 611, § 23, 
effective July 1. L. 88: (l)(x)(I) and (2) amended and (l)(x)(VIII) and (l)(x.5) added, p. 
991, § 1, effective May 11; (l)(ee) added, p. 998, § 2, effective May ILL. 91: (l)(ee)(II) 
amended, p. 1162, § 1, effective March 29; (l)(ee)(VI) amended, p. 929, § 1, effective 
April 1; (l)(bb) and (l)(ee)(IV) amended, pp. 720, 1856, §§ 2, 11, effective April 11; (l)(a), 
(l)(f), (l)(z), and (l)(dd) amended, p. 941, § 1, effective May 5; (3) amended, p. 974, § 3, 
effective May 6; (l)(fO added, p. 442, § 9, effective May 29; (l)(x)(I) and (l)(x)(II)(A) 
amended, p. 961, § 1, effective July 1. L. 92: (l)(w) and (l)(ee) amended, pp. 1727, 1151, 
§§ 17, 8, effective July 1. L. 93: (l)(ee)(I)(B) amended, p. 1786, § 67, effective June 6; 
(l)(aa) amended, p. 1664, § 71, effective July 1; (1)(1)(II.5) added and (l)(u), IP(l)(ee)(I), 
(l)(ee)(I)(C), and (l)(ee)(II.5)(D) amended, pp. 1096, 1140, §§ 12, 13, 77, effective July 1, 
1994. L. 94: (3)(c) amended, p. 695, § 1, effective April 19; (l)(ee)(II.5)(A) and (3)(c)(II) 
amended, p. 1638, § 55, effective May 31; (l)(n), (1)(1)(II.5), and (l)(ee)(II) amended and 
(4) added, pp. 2700, 2606, 2610, §§ 252, 7, 10, effective July 1; (l)(q) amended, p. 1665, 
§ 1, effective July 1. L. 95: (l)(ee)(II.5)(H) and (l)(ee)(II.5)(I) amended and (l)(ee)(II)(J) 
added, p. 539, § 1, effective May 22; (l)(gg) added, p. 943, § 5, effective May 25; (1)(1)(I), 
(1)(1)(II), (l)(l)(II.l), and (1)(1)(III) amended and (1)(1)(II.2) added, p. 1021, § 1, effective 
July 1. L. 96: (l)(ee)(VI)(B) amended, p. 798, § 11, effective May 23; (l)(ee)(VII) 
repealed, p. 1253, § 138, effective August 7; (l)(ee)(II.5)(B) amended, p. 1695, § 37, 
effective January 1, 1997. L. 98: (l)(hh) added, p. 711, § 1, effective May 18; (l)(ee)(1.5), 
(l)(ee)(II.5)(I), (l)(ee)(III)(B), and (l)(ee)(VI) amended and (l)(ee)(1.6) added, p. 542, § 4, 
effective July 1; (l)(x)(II)(A) amended and (l)(x)(IX) added, p. 888, § 1, effective August 
5. L. 99: (l)(y) amended, p.436, § 5, effective April 30; (l)(x)(VII) amended and (l)(x.2) 
added, p. 23, § 1, effective July 1. L. 2000: (l)(a.5) added, p. 87, § 5, effective March 15; 
IP(l)(x)(VII), (l)(x)(VII)(D), and (l)(x.2) amended and (l)(x)(VII)(E) added, p. 144, § 1, 
effective March 16; (l)(n) amended, p. 802, § 1, effective May 24; (l)(ii) added, p. 2002, 



Title 25 - page 1 1 Administration 25-1-1 07.5 

§ 1, effective August 2. L. 2001: (l)(jj) added, p. 473, § 2, effective April 27; (l)(kk) 
added, p. 928, § 4, effective June 4; (l)(n)(I) amended, p. 1274, § 36, effective June 5; 
(l)(a.5)(IV), (l)(a.5)(V), and (l)(a.5)(VI) added, p. 824, § 1, effective August 8. L. 2002: 
(l)(x)(VII)(C.5) amended, p. 1024, § 45, effective June 1; (1)(1)(I) and (4) amended, p. 
1327, § 14, effective July 1; (l)(m) amended, p. 411, § 4, effective July 1; (l)(q) amended, 
p. 427, § 3, effective July 1. L. 2003: (1)(11) added, p. 1035, § 7, effective April 17; 
(l)(ee)(IL5)(A) and (l)(ee)(IL5)(C) amended, p. 1997, § 45, effective May 22; entire 
section repealed, p. 676, § 1, effective July 1; IP(l)(a.5)(IV) amended, p. 1617, § 23, 
effective August 6. 

Editor's note: This section was repealed, effective July 1, 2003, and relocated to article 1.5 of this 
title. Prior to its repeal, this section was amended by House Bill 03-1266, House Bill 03-1344, and 
House Bill 03-1100. Those amendments have been relocated and harmonized with article 1.5 of this 
tide. Amendments to the introductory portion to subsection (l)(a.5)(IV) by House Bill 03-1266 were 
harmonized with Senate Bill 03-002 and relocated to the introductory portion to § 25-1.5-102 
(l)(b)(IV). Amendments to subsections (l)(ee)(II.5)(A) and (l)(ee)(II.5)(C) by House Bill 03-1344 
were harmonized with Senate Bill 03-002 and relocated to § 25-1.5-301 (2)(a) and (2)(b.5), 
respectively. Subsection (1)(11) as enacted by House Bill 03-1100 was harmonized with Senate Bill 
03-002 and relocated to § 25-1.5-101 (l)(y). 

25-1-107.5. Additional authority of department - rules - remedies against nursing 
facilities - criteria for recommending assessments for civil penalties - cooperation with 
department of health care policy and financing - nursing home penalty cash fund - 
accountability board - reports - repeal. (1) For the purposes of this section, unless the 
context otherwise requires: 

(a) "Accountability board" means the nursing facility culture change accountability 
board, authorized by subsection (6) of this section. 

(b) "Federal regulations for participation" means the regulations found in part 442 of 
title 42 of the code of federal regulations, as amended, for participation under Tide XIX of 
the federal "Social Security Act", as amended. 

(c) "Nursing facility" means any skilled or intermediate nursing care facility that 
receives federal and state funds under Title XIX of the federal "Social Security Act", as 
amended. 

(2) The department, as the state agency responsible for certifying nursing facilities, is 
authorized to adopt rules necessary to establish a series of remedies in accordance with this 
section and the federal "Omnibus Budget Reconciliation Act of 1987", Pub.L. 100-203, as 
amended, that may be imposed by the department of health care policy and financing when 
a nursing facility violates federal regulations for participation in the medicaid program. The 
remedies shall include any remedies required under federal law and the imposition of civil 
money penalties. 

(3) (a) In accordance with rules promulgated under this section, the department is 
authorized to recommend to the department of health care policy and financing an 
appropriate civil money penalty based on the nature of the violation. Any penalties 
recommended shall not be less than one hundred dollars nor more than ten thousand dollars 
for each day the facility is found to be in violation of the federal regulations. Penalties 
assessed shall include interest at the statutory rate. 

(b) The department shall adopt criteria for determining the amount of the penalty to be 
recommended for assessment. The criteria shall include, but need not be limited to, 
consideration of the following factors: 

(I) The period during which the violation occurred; 

(II) The frequency of the violation; 

(III) The nursing facility's history concerning the type of violation for which the 
penalty is assessed; 

(IV) The nursing facility's intent or reason for the violation; 

(V) The effect, if any, of the violation on the health, safety, security, or welfare of the 
residents of the nursing facility; 



25-1-107.5 Health Title 25 - page 12 

(VI) The existence of other violations, in combination with the violation for which the 
penalty is assessed, that increase the threat to the health, safety, security, or welfare of the 
residents of the nursing facility; 

(VII) The accuracy, thoroughness, and availability of records regarding the violation 
that the nursing facility is required to maintain; and 

(VIII) The number of additional related violations occurring within the same period as 
the violation in question. 

(c) (I) If the department finds that a violation is life threatening to one or more 
residents or creates a direct threat of serious adverse harm to the health, safety, security, 
rights, or welfare of one or more residents, the department of health care policy and 
financing shall impose a penalty for each day the deficiencies that constitute the violation 
are found to exist. 

(II) Except as provided in subparagraph (I) of this paragraph (c), the department of 
health care policy and financing shall not assess a penalty prior to the date a nursing facihty 
receives written notice from the department of its recommendation to assess civil money 
penalties. The department shall provide the notice to the facility no later than five days after 
the last day of the inspection or survey during which the deficiencies that constitute the 
violation were found. The notice shall: 

(A) Set forth the deficiencies that are the basis for the recommendation to assess a 
penalty; 

(B) Provide instructions for responding to the notice; and 

(C) Require the nursing facility to submit a written plan of correction. The department 
shall adopt criteria for the submission of written plans of correction by nursing facilities and 
approval of the plans by the department. If the facility acts in a timely and diligent manner 
to correct the violation in accordance with an approved plan of correction, the department 
may recommend to the department of health care policy and financing that it suspend or 
reduce the penalty during the period of correction specified in the approved plan of 
correction. 

(d) Except as provided in sub-subparagraph (C) of subparagraph (II) of paragraph (c) 
of this subsection (3), the department of health care policy and financing shall continue to 
assess any penalty recommended under this section until the department verifies to the 
department of health care policy and financing that the violation is corrected or until the 
nursing facility notifies the department that correction has occurred, whichever is earlier. If 
the penalty has been suspended or reduced pursuant to sub-subparagraph (C) of subpara- 
graph (II) of paragraph (c) of this subsection (3) and the nursing facility has not corrected 
the violation, the department of health care policy and financing shall reinstate the penalty 
at an increased amount and shall retroactively assess the penalty to the date the penalty was 
suspended. 

(4) (a) The department of health care policy and financing, after receiving a recom- 
mendation from the department, is authorized to assess, enforce, and collect the civil money 
penalty pursuant to section 25.5-6-205, C.R.S., for credit to the nursing home penalty cash 
fund, created pursuant to section 25.5-6-205 (3) (a), C.R.S. 

(b) (I) The department of public health and environment and the department of health 
care policy and financing have joint authority for administering the nursing home penalty 
cash fund; except that final authority regarding the administration of moneys in the fund is 
in the department of health care policy and financing. 

(II) The authority of both departments includes establishing circumstances under which 
funds may be distributed in order to protect the health or property of individuals residing 
in nursing facilities that the department of health care policy and financing has found to be 
in violation of federal regulations for participation in the medicaid program. 

(III) The department of health care policy and financing shall promulgate rules neces- 
sary to ensure proper administration of the nursing home penalty cash fund. 

(c) The departments shall consider, as a basis for distribution from the nursing home 
penalty cash fund, the following: 

(I) The need to pay costs to: 

(A) Relocate residents to other facilities when a nursing facility closes; 

(B) Maintain the operation of a nursing facility pending correction of violations; 



Title 25 - page 13 Administration 25-1-107.5 

(C) Close a nursing facility; 

(D) Reimburse residents for personal funds lost; 

(II) Measures that will benefit residents of nursing facilities by improving their quality 
of life at the facilities, including: 

(A) Consumer education to promote resident-centered care in nursing facilities; 

(B) Training for state surveyors, supervisors, and the state and local long-term care 
ombudsman, established pursuant to article 11.5 of title 26, C.R.S., regarding resident- 
centered care in nursing facilities; 

(C) Development of a newsletter and web site detailing information on resident- 
centered care in nursing facilities and related information; and 

(D) Education and consultation for purposes of identifying and implementing resident- 
centered care initiatives in nursing facilities. 

(d) (I) The departments shall distribute the following amounts of moneys in the 
nursing home penalty cash fund for the purposes described in subparagraph (II) of 
paragraph (c) of this subsection (4): 

(A) For the 2009-10 fiscal year, two hundred thousand dollars; 

(B) For the 2010-11 fiscal year and each fiscal year thereafter, an amount equal to the 
lesser of the amount specified in a budget approved by the accountability board or 
twenty-five percent of the moneys deposited into the nursing home penalty cash fund in the 
immediately preceding fiscal year. 

(II) The departments may allocate the moneys specified in this paragraph (d) on a 
quarterly basis, but in no case shall the total amount distributed in any given fiscal year 
exceed the amount specified in subparagraph (I) of this paragraph (d). 

(III) Notwithstanding subparagraph (I) of this paragraph (d), the departments shall 
ensure that the balance of the nursing home penalty cash fund does not fall below one 
million dollars as a result of expenditures for the purposes described in subparagraph (II) 
of paragraph (c) of this subsection (4) and shall not distribute moneys pursuant to this 
paragraph (d) for such purposes if making a distribution would cause the fund balance to 
fall below the minimum balance required by this subparagraph (III). 

(IV) In determining how to allocate the moneys authorized to be distributed pursuant 
to this paragraph (d), the departments shall take into consideration the recommendations of 
the accountability board made pursuant to paragraph (c) of subsection (6) of this section. If 
the departments disagree with the recommendations of the accountability board, they shall 
meet with the accountability board to explain their rationale and shall seek to achieve a 
compromise with the accountability board regarding the allocation of the moneys. If a 
compromise cannot be achieved with regard to all or a portion of the moneys to be 
distributed, the medical services board created pursuant to section 25.5-1-301, C.R.S., shall 
have the final authority regarding the distribution of moneys for which a compromise has 
not been reached. 

(e) The departments shall not utilize moneys from the nursing home penalty cash fund 
for the purpose of paying their cost for administering such fund or for any administration 
costs associated with any specific movement, association, or organization; except that up to 
ten percent of the moneys distributed pursuant to paragraph (d) of this subsection (4) may 
be used to pay the cost to administer and operate the accountability board, including 
expense reimbursement for accountability board members. 

(5) Repealed. 

(6) (a) No later than September 1, 2009, the nursing facility culture change account- 
ability board shall be established and operated under the department of health care policy 
and financing either directly or by contract with or grant to any public agency or appropriate 
private nonprofit organization. The department of health care policy and financing, in 
consultation with stakeholders, shall determine the appropriate entity to administer the 
accountability board. The accountability board shall be composed of ten members as 
follows: 

(I) The state long-term care ombudsman or his or her designee; 

(II) The executive director of the department of health care policy and financing or the 
executive director's designee; 



25-1-108 Health Title 25 - page 14 

(III) The executive director of the department of public health and environment or the 
executive director's designee; 

(IV) Seven members appointed by the governor as follows: 

(A) Three members currently employed in long-term care nursing facilities; 

(B) One member who is or represents a consumer of long-term care; 

(C) One member representing the disability community who is either a resident of a 
nursing facility or a family member of a nursing facility resident; 

(D) One member representing the business community; and 

(E) One member representing the Colorado culture change coalition, or its successor 
organization. 

(b) The members of the accountability board shall serve without compensation but may 
be reimbursed for expenses incurred while serving on the accountability board. 

(c) The accountability board shall review and make recommendations to the depart- 
ments regarding the use of moneys in the nursing home penalty cash fund for the purposes 
described in subparagraph (II) of paragraph (c) of subsection (4) of this section. 

(d) By October 1, 2010, and by each October 1 thereafter, the departments, with the 
assistance of the accountability board, shall jointly submit a report to the governor and the 
health and human services committees of the senate and house of representatives of the 
general assembly, or their successor committees, regarding the expenditure of moneys in the 
nursing home penalty cash fund for the purposes described in subparagraph (II) of 
paragraph (c) of subsection (4) of this section. The report shall detail the amount of moneys 
expended for such purposes, the recipients of the funds, the effectiveness of the use of the 
funds, and any other information deemed pertinent by the departments or requested by the 
governor or the committees. 

(7) (a) Subparagraph (II) of paragraph (c) of subsection (4) of this section, subsection 
(6) of this section, and this subsection (7) are repealed, effective September 1, 2016. 

(b) Prior to such repeal, the nursing facility culture change accountability board and its 
functions, and the use of moneys in the nursing home penalty cash fund for the purposes 
described in subparagraph (II) of paragraph (c) of subsection (4) of this section, shall be 
reviewed pursuant to section 24-34-104, C.R.S. 

Source: L. 89, 1st Ex. Sess.: Entire section added, p. 24, § 1, effective July ILL. 91: 
(3)(b) amended, p. 1856, § 12, effective April 11; (4) added, p. 687, § 53, effective April 
20; entire section repealed, p. 687, § 53, effective July 1, 1993. L. 94: Entire section 
RC&RE, p. 1316, § 1, effective May 25; (2), (3)(a), (3)(c)(II)(C), (3)(d), (4)(a), and (4)(b) 
amended, p. 2617, § 29, effective July 1. L. 97: (5) repealed, p. 106, § 2, effective March 
24. L. 2006: (4)(a) amended, p. 2012, § 80, effective July 1. L. 2009: Entire section 
amended, (HB 09-1196), ch. 428, p. 2383, § 1, effective June 4. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(2), (3)(a), (3)(c)(II)(C), (3)(d), (4)(a), and (4)(b), see section 1 of chapter 345, Session Laws of 
Colorado 1994. 

ANNOTATION 

Section does not require recipient to ex- the administrative process and therefore admin- 

haust all administrative remedies prior to istrative process was not a prerequisite to filing 

filing a common law tort claim against pro- claims. Salas v. Grancare, Inc., 22 P.3d 568 

vider. Reimbursement of amounts paid by or on (Colo. App. 2001). 
behalf of the recipient was not available through 

25-1-108. Powers and duties of state board of health. (1) In addition to all other 
powers and duties conferred and imposed upon the state board of health by the provisions 
of this part 1, the board has the following specific powers and duties: 

(a) To determine general policies to be followed by the division of administration in 
administering and enforcing the public health laws and the orders, standards, rules, and 
regulations of the board; 



Title 25 - page 15 Administration 25-1-108 

(b) To act in an advisory capacity to the executive director of the department on all 
matters pertaining to public health; 

(c) (I) To issue from time to time such orders, to adopt such rules and regulations, and 
to establish such standards as the board may deem necessary or proper to carry out the 
provisions and purposes of this part 1 and to administer and enforce the public health laws 
of this state; 

(II) To adopt rules and regulations and standards concerning building regulations and 
fire safety for skilled and intermediate health care facilities. The enforcement of these rules 
and regulations may be waived by the board for periods of time as recommended by the 
department if the rigid application thereof would result in demonstrated financial hardship 
to a skilled or intermediate facility, but only if the waiver will not adversely affect the health 
and safety of patients. 

(III) All rules, regulations, and standards adopted prior to February 21, 1947, by the 
board concerning building regulations or fire safety for nursing homes which are more strict 
than those provided by the highest standards as set forth in this paragraph (c) are nullified 
by this section, but nothing contained in this paragraph (c) shall be construed to prevent the 
department from adopting and enforcing, with respect to projects for which federal 
assistance has been obtained or shall be requested, such higher standards as may be required 
by applicable federal laws or regulations of federal agencies responsible for the adminis- 
tration of such federal laws. 

(IV) For the purpose of this part 1, all rules, regulations, and standards adopted prior 
to February 21, 1947, by the board or any board, office, or bureau whose duties are by virtue 
of this section transferred to the board or the department, in effect immediately prior to 
February 21, 1947, and not inconsistent with the authority of the board as provided in this 
part 1 shall remain in full force and effect until superseded by rules, regulations, or 
standards duly adopted pursuant to this paragraph (c) by the board in conformance with this 
part 1, to the same effect as though such rules, regulations, and standards were adopted 
subsequent to the passage of this part 1 in full conformance therewith. 

(V) Repealed. 

(VI) To adopt rules and to establish such standards as the board may deem necessary 
or proper to assure that hospitals, other acute care facilities, county, district, and municipal 
public health agencies, trauma centers, area trauma advisory councils, and managed care 
organizations are prepared for an emergency epidemic, as defined in section 24-32-2103 
(1.7), C.R.S., that is declared to be a disaster emergency, including the immediate inves- 
tigation of any case of a suspected emergency epidemic. 

(d) To hold hearings, administer oaths, subpoena witnesses, and take testimony in all 
matters relating to the exercise and performance of the powers and duties vested in or 
imposed upon the board. The board may designate an administrative law judge appointed 
pursuant to part 10 of article 30 of title 24, C.R.S., to conduct hearings for the board, 
pursuant to section 24-4-105, C.R.S., and to carry out such administrative and other duties 
of the board as the board may require in the conduct of its hearings. 

(e) To establish and appoint, as the board may deem necessary or advisable, special 
advisory committees to advise and confer with the board concerning the public health 
aspects of any business, profession, or industry within the state of Colorado. Any committee 
established and appointed under the provisions of this section shall act only in an advisory 
capacity to the board and shall meet with the board at least once each year at such regular 
meeting of the board as may be designated by the board and at such other times as such 
committee may be called into meeting by the president of the board. Members of any 
special advisory committee shall serve without compensation but may, in the discretion of 
the board, be allowed actual and necessary traveling and subsistence expenses when in 
attendance at meetings away from their places of residence. 

(f) To accept and, through the division of administration, use, disburse, and administer 
all federal aid or other property, services, and moneys allotted to the department for state 
and local public works or public health functions, or allotted without designation of a 
specific agency for purposes which are within the functions of the department; and to 



25-1-108 



Health 



Title 25 -page 16 



prescribe, by rule or regulation not inconsistent with the laws of this state, the conditions 
under which such property, services, or moneys shall be accepted and administered. On 
behalf of the state, the board is empowered to make such agreements, with the approval of 
the attorney general, not inconsistent with the laws of this state, as may be required as a 
condition precedent to receiving such funds or other assistance. 

(g) Repealed. 

(h) To comply with the requirements of section 24-1-136.5, C.R.S., concerning the 
preparation of operational master plans, facilities master plans, and facilities program plans, 
as if the state board of health were the executive director of the department. 

(2) The board shall act only by resolution adopted at a duly called meeting of the board, 
and no individual member of the board shall exercise individually any administrative 
authority with respect to the department. 

(3) In the exercise of its powers, the department shall not promulgate any rule or 
standard that limits or interferes with the ability of an individual to enter into a contract with 
a private pay facility concerning the programs or services provided at the private pay 
facility. For the purposes of this subsection (3), "private pay facility" means a skilled 
nursing facility or intermediate care facility subject to the requirements of section 25-1-120 
or an assisted living residence licensed pursuant to section 25-27-105 that is not publicly 
funded or is not certified to provide services that are reimbursed from state or federal 
assistance funds. 

(4) and (5) Repealed. 

Source: L. 47: p. 511, § 6. CSA: C. 78, § 21(6). CRS 53: § 66-1-8. L. 55: p. 428, 
§ 2.L. 59: p. 468, § 2. C.R.S. 1963: § 66-1-8. L. 67: p. 345, § 16. L. 68: pp. 107, 108, 
§§ 77, 81. L. 75: (l)(c)(II) R&RE, p. 871, § 1, effective July 14; (l)(d) amended, p. 872, 
§ 1, effective July 14. L. 77: (l)(d) amended, p. 308, § 12, effective June 10. L. 87: (l)(d) 
amended, p. 967, § 76, effective March 13. L. 92: (l)(g) added, p. 1236, § 3, effective 
August 1. L. 94: (l)(c)(V) added, p. 32, § 5, effective March 9; (l)(h) added, p. 565, § 13, 
effective April 6; (3) added, p. 2610, § 1 1, effective July 1. L. 96: (l)(g) repealed, p. 1284, 
§ 1, effective June 1. L. 2000: (l)(c)(VI) added, p. 88, § 6, effective March 15; (4) added, 
p. 545, § 23, effective July 1. L. 2002: (3) amended and (5) added, p. 1328, § 15, effective 
July 1. L. 2003: (5) amended, p. 2007, § 84, effective May 22. L. 2006: (l)(c)(V) 
repealed, p. 1 1 27, § 1 , effective July 1 . L. 2007: (5) amended, p. 2040, § 62, effective June 
1. L. 2008: (5) repealed, p. 662, § 1, effective August 5. L. 2010: (l)(c)(VI) amended, 
(HB 10-1422), ch. 419, p. 2089, § 83, effective August 11. 

Editor's note: Subsection (4)(d) provided for the repeal of subsection (4), effective November 31, 
2000, but the date was changed on revision to November 30, 2000. (See L. 2000, p. 545.) 

Cross references: (1) For the duty of the board to supervise registration of births and deaths, see 
article 2 of this title. 

(2) For the legislative declaration contained in the 1994 act adding subsection (3), see section 1 
of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 



Regulations held not unconstitutionally ap- 
plied. Federal regulations adopted by the de- 
partment of health were held not to be so vague 
that their application would deprive the regu- 
lated party of procedural due process. Geriatrics, 
Inc. V. State Dept. of Health, 650 P.2d 1288 
(Colo. App. 1982), aff'd in part, rev'd in part on 
other grounds, 699 P.2d 952 (Colo. 1985). 

State licensing standards which provided the 
basis for the revocation of a nursing facility's 



operating license were not in violation of the 
regulated party's due process rights for the regu- 
lations were detailed and specific and the final 
agency decision set out detailed findings con- 
cerning the revocation of the operating license. 
State Dept. of Health v. Geriatrics, 699 P.2d 952 
(Colo. 1985). 

Applied in Winkler v. State Dept. of Health, 
193 Colo. 170, 564 P.2d 107 (1977). 



Title 25 - page 17 Administration 25-1-108.5 

25-1-108.5. Additional powers and duties of state board of health and department 
- programs that receive tobacco settlement moneys - monitoring - annual report. 

(1) As used in this section: 

(a) "Health sciences facility" has the meaning set forth in section 25-31-103. 

(b) "Master settlement agreement" means the master settlement agreement, the smoke- 
less tobacco master settlement agreement, and the consent decree approved and entered by 
the court in the case denominated State of Colorado, ex re I. Gale A. Norton, Attorney 
General v. R.J. Reynolds Tobacco Co.; American Tobacco Co., Inc.; Brown & Williamson 
Tobacco Corp.; Liggett & Myers, Inc.; Lorillard Tobacco Co., Inc.; Philip Morris, Inc.; 
United States Tobacco Co.; B.A.T Industries, P.L.C; The Council For Tobacco Research — 
U.S.A., Inc.; and Tobacco Institute, Inc., Case No. 97 CV 3432, in the district court for the 
city and county of Denver. 

(c) "Nurse home visitor program" means the tobacco settlement program established in 
article 31 of this title. 

(d) "Tobacco settlement program" means any program that receives appropriations 
from moneys received by the state pursuant to the master settlement agreement. 

(2) Except for the nurse home visitor program, which shall be monitored by the health 
sciences facility in accordance with section 25-31-105 (1), the state board and the 
department shall monitor the operation and effectiveness of tobacco settlement programs. 
Each tobacco settlement program shall annually submit to the department, in accordance 
with rules promulgated by the state board, the following information: 

(a) The amount of tobacco settlement moneys received by the program for the 
preceding fiscal year; 

(b) A description of the program, including the program goals, the population served by 
the program, including the actual number of persons served, and the services provided 
through the program; 

(c) Information evaluating the operation of the program, including the effectiveness of 
the program in achieving its stated goals; and 

(d) Any other information required by rule of the state board. 

(3) (a) On or before January 15, 2002, and on or before each January 15 thereafter, the 
department shall submit to the joint budget committee, the health and human services 
committees of the senate and the house of representatives, or any successor committees, the 
attorney general, and the governor a report summarizing the information received by the 
department pursuant to subsection (2) of this section. In addition, the report shall include: 

(I) The reports prepared by the state auditor during the preceding fiscal year pursuant 
to section 2-3-113, C.R.S., reviewing and evaluating tobacco settlement programs, so long 
as such reports have been previously released by the audit committee; and 

(II) The state board's recommendations concerning any programs for which funding 
should be discontinued and any additional programs for which the general assembly should 
consider appropriating moneys received pursuant to the master settlement agreement. 

(b) The report prepared pursuant to this subsection (3) shall also be available upon 
request to any member of the public. 

(4) The state board shall adopt rules to ensure that no person who is involved in 
evaluating tobacco settlement programs pursuant to this section has a conflict of interest in 
conducting such evaluations, including but not limited to any conflict involving the person 
and the recipient of any tobacco settlement program moneys and any conflict involving the 
person and the tobacco industry. If the state board determines that a person has a conflict, 
as described by rule, the state board shall prohibit that person from participating in any 
reviews that may be affected by the conflict. 

(5) Each tobacco settlement program shall pay a proportionate share of the costs 
incurred by the department in implementing the requirements of this section, with the 
amount paid by each tobacco settlement program proportionate to the amounts annually 
appropriated to each tobacco settlement program from the master settlement agreement; 
except that the total amount of the program evaluation costs shall not exceed four-tenths of 
one percent of the total amount of moneys received by the state pursuant to the master 
settlement agreement in any fiscal year. 



25-1-108.7 Health Title 25 - page 18 

Source: L. 2000: Entire section added, p. 592, § 2, effective May 18. L. 2002: (5) 

amended, p. 778, § 2, effective May 30. L. 2003: (5) amended, p. 1665, § 2, effective July 
1. L. 2007: IP(3)(a) amended, p. 2040, § 63, effective June 1. L. 2010: (1), IP(2), and (5) 
amended, (SB 10-073), ch. 386, p. 1807, § 2, effective June 30. 

25-1-108.7. Health care credentials uniform application act - legislative declara- 
tion - definitions - state board of health rules. (1) This section shall be known and may 
be cited as the "Health Care Credentials Uniform Application Act". 

(2) The purpose of the "Health Care Credentials Uniform Application Act" is to make 
credentialing more efficient, less costly, and less duplicative by making it uniform through 
the use of a single application form for the collection of core credentials data for use by 
entities. 

(3) As used in this section, unless the context otherwise requires: 

(a) "Core credentials data" means data, information, or answers to questions that are 
collected and retained and that are common and necessary for the credentialing or 
recredentialing of a health care professional, but does not include additional nonduplicative 
credentials data deemed essential by a credentialing entity to complete credentialing. 

(b) "Credentialing" means the process of assessing and validating the qualifications of 
a health care professional. 

(c) "Credentialing entity" means any health care entity or health care plan that is 
engaged in the collection of information to be used in the process of credentialing or 
recredentialing of health care professionals. 

(d) "Health care entity" means any of the following that require health professionals to 
submit credentials data: 

(I) A health care facility or other health care organization licensed or certified to 
provide medical or health services in Colorado; 

(II) A health care professional partnership, corporation, limited liability company, 
professional services corporation, or group practice; 

(III) An independent practice association or physician-hospital organization; 

(IV) A professional liability insurance carrier; or 

(V) An insurance company, health maintenance organization, or other entity that 
contracts for the provision of health benefits. 

(e) "Health care plan" means any entity that is licensed by the division of insurance as 
a prepaid health care plan, health maintenance organization, or insurer and that requires the 
submission of credentials data. 

(f) "Health care professional" means a physician, dentist, dental hygienist, chiroprac- 
tor, podiatrist, psychologist, advanced practice nurse, optometrist, physician assistant, 
Hcensed clinical social worker, child health associate, marriage and family therapist, or 
other health care professional who is registered, certified, or licensed pursuant to title 12, 
C.R.S.; who is subject to credentialing; and who practices, or intends to practice, in 
Colorado. 

(g) "Nonspecific credentials data" means credentials data that is aggregated and 
reported without reference to the identity of the individual health care professional to whom 
it pertains. 

(4) (a) Nothing in this section shall be construed to restrict the authority of any health 
care entity or health care plan to approve, suspend, or deny an application for insurance, 
staff membership, clinical privileges, or managed care network participation. This section 
shall not be construed to apply to the licensing activities of any board responsible for 
licensing health care professionals. 

(b) Nothing in this section shall be construed to require a credentialing entity to use a 
particular credentialing process or to restrict or require such an entity from using a 
particular vendor in the credentialing process. 

(5) Upon the effective date of the rule established by the state board of health pursuant 
to paragraph (e) of subsection (6) of this section, a credentialing entity shall collect core 
credentials data through the use of the Colorado health care professional credentials 
application established pursuant to paragraph (a) of subsection (6) of this section. The form 
may be submitted electronically or by paper copy. The credentialing entity may require a 



Title 25 - page 19 Administration 25-1-108.7 

health care professional to answer only select provisions of the application according to the 
needs of the entity. Questions that are prohibited by law shall not be included in the request 
for credentialing data by the credentialing entity. 

(6) (a) There is hereby established the health care credentials application review 
committee to recommend to the state board of health, and to periodically review, a single 
application form for the collection of core credentials data in this state. The form shall be 
known as the "Colorado health care professional credentials appUcation". The review 
committee shall consist of the following eight members, who shall serve for terms of four 
years and who shall be appointed by the state board of health: 

(I) One member representing a statewide association or society of physicians; 

(II) One member representing a statewide association or society of Colorado hospitals; 

(III) One member representing a statewide association or society of health plans; 

(IV) One member representing a professional liability insurance carrier domiciled in 
Colorado that provides professional liability insurance to health care professionals in 
Colorado; 

(V) One member representing a statewide association or society of Colorado health 
care medical staff service specialists; 

(VI) One advanced practice nurse; 

(VII) Two members at large. 

(b) Each board member may bring consultants and advisors to participate in board 
meetings. Consultants and advisors shall not have decision-making powers or voting 
privileges. 

(c) The review committee shall be staffed by an entity approved by the Colorado 
medical board to collect medical license registration fees pursuant to section 12-36-123.5, 
C.R.S. 

(d) Members of the review committee shall serve without compensation. 

(e) Within one hundred twenty days after the time of appointment, the review com- 
mittee shall make a recommendation to the state board of health regarding proposed 
contents of the Colorado health care professional credentials application. In accordance 
with section 24-4-103, C.R.S. , the state board of health shall establish, by rule, the Colorado 
health care professional credentials application. The Colorado health care professional 
credentials application shall be the same as the provider application form developed by the 
council for affordable quality healthcare as of January 1 , 2004, as modified, if necessary, to 
comply with Colorado law or as may be recommended by the majority of members of the 
review committee. 

(f) The review committee shall meet at least annually to review and make any 
necessary recommendations for modifications to the Colorado health care professional 
credentials application to the state board of health. 

(g) Initial appointments to the review committee shall be made on or before July 1, 
2004. The state board of health shall appoint replacement members as necessary for a full 
committee. 

(h) On or before September 1, 2008, the review committee shall make recommenda- 
tions to the board concerning the feasibility of requiring all requests for additional 
credentials data deemed essential by a credentialing entity be uniform among all 
credentialing committees by July 1, 2009. On or before March 1, 2009, the review 
committee shall make recommendations to the board concerning the feasibility of requiring 
all Colorado health care professional credentials applications to be submitted through online 
electronic methods and that all health care entities required by this section to use the health 
care professional credentials application be required to accept and process the application 
through electronic means by January 1, 2010. If determined feasible by the board, the board 
shall establish by rule the standards, means, methods, and forms necessary to require the use 
of uniform supplemental questions and the submission, receipt, and processing of the health 
care professional credentials application electronically. 

(7) Core credentials data collected and retained on behalf of a credentialing entity shall 
not be modified without the approval of the credentialing entity. 

(8) The state board of health may promulgate rules as necessary to carry out the 
provisions of this section. 



25-1-109 Health Title 25 - page 20 

(9) (Deleted by amendment, L. 2008, p. 688, § 1, effective July 1, 2008.) 

Source: L. 2004: Entire section added, p. 466, § 1, effective April 14. L. 2008: (2), (5), 
and (9) amended and (6)(h) added, pp. 688, 689, §§ 1,2, effective July 1. L. 2010: (6)(c) 
amended, (HB 10-1260), ch. 403, p. 1990, § 85, effective July 1. 

25-1-109. Powers and duties of division of administration. (1) In addition to the 
other powers and duties conferred and imposed in this part 1 upon the division of 
administration, the division, through the director or, upon the director's direction and under 
the director's supervision, through the other officers and employees of the division, has the 
following powers and duties: 

(a) To administer and enforce the public health laws of the state of Colorado and the 
standards, orders, rules, and regulations established, issued, or adopted by the board; 

(b) To exercise all powers and duties conferred and imposed upon the department not 
expressly delegated to the board by the provisions of this part 1 ; 

(c) To hold hearings, administer oaths, subpoena witnesses, and take testimony in all 
matters relating to the exercise and performance of the powers and duties vested in or 
imposed upon the division of administration. The director may designate an administrative 
law judge appointed pursuant to part 10 of article 30 of title 24, C.R.S., to conduct hearings 
pursuant to section 24-4-105, C.R.S. 

(d) Repealed. 

(e) To supervise all subdivisions and boards of the department to determine that 
publications of the department and of any subdivisions thereof circulated in quantity outside 
the executive branch are issued in accordance with the provisions of section 24-1-136, 
C.R.S.; 

(f) To appoint, pursuant to section 13 of article XII of the state constitution, a chief 
health inspector and such deputy inspectors as may be authorized. Such inspectors have the 
power to enter any workplace as provided in section 8-1-116, C.R.S. All expenses incurred 
by the division and its employees, pursuant to the provisions of this section, shall be paid 
from the funds appropriated for its use, upon approval of the director. 

(g) Repealed. 

(h) To administer and enforce the minimum general sanitary standards and regulations 
adopted pursuant to section 25-1.5-202. 

Source: L. 47: p. 513, § 7. CSA: C. 78, § 21(7). CRS 53: § 66-1-9. C.R.S. 1963: 

§ 66-1-9. L. 64: p. 140, § 68. L. 73: p. 917, § 1. L. 77: (l)(h) added, p. 1261, § 2, 
effective June 9; (l)(c) amended, p. 308, § 13, effective June 10. L. 80: (l)(f) amended and 
(l)(g) repealed, pp. 450, 451, §§ 5, 6, effective April 13. L. 83: (l)(d) and (l)(e) amended, 
p. 839, § 58, effective July 1. L. 87: (l)(c) amended, p. 967, § 77, effective March 13. 
L. 96: (l)(d) repealed, p. 1256, § 145, effective August 7. L. 2003: IP(1) and (l)(h) 
amended, p. 706, § 31, effective July 1. 

Cross references: For the legislative declaration contained in the 1996 act amending this section, 
see section 1 of chapter 237, Session Laws of Colorado 1996. 

ANNOTATION 

Subsection (l)(c) grants subject matter Ju- matters, such as nursing care services. Geriat- 

risdiction. Subsection (l)(c) gives the depart- rics, Inc. v. State Dept. of Health, 650 P.2d 1288 

ment of health subject matter jurisdiction to (Colo. App. 1982), affd in part and rev'd in part 

conduct hearings relating generally to health on other grounds, 699 P.2d 952 (Colo. 1985). 

25-1-110. Higher standards permissible. Nothing in this part 1 shall prevent any 
incorporated city, city and county, town, county, or other political subdivision of the state 
from imposing and enforcing higher standards than are imposed under this part 1. 



Title 25 - page 2 1 Administration 25- 1 - 1 1 3 

Source: L. 47: p. 513, § 7A. CSA: C. 78, § 21(8). CRS 53: § 66-1-10. C.R.S. 1963: 

§ 66-1-10. 

25-1-111. Revenues of department. 

(1) Repealed. 

(2) The department of the treasury of this state is designated as custodian of all funds 
allotted to the state for the purpose outlined by section 25-1-108 (1) (f)- Such funds and all 
other funds of the department shall be payable only on voucher signed by the executive 
director of the department and by the president of the board and shall be paid by warrant 
of the controller. 

Source: L. 47: p. 514, § 9. CSA: C. 78, § 21(10). CRS 53: § 66-1-11. C.R.S. 1963: 
§ 66-1-11. L. 87: (1) repealed, p. 1124, § 1, effective July 1. 

25-1-112. Legal adviser - actions. The attorney general shall be the legal adviser for 
the department and shall defend it in all actions and proceedings brought against it. The 
district attorney of the judicial district in which a cause of action may arise shall bring any 
action, civil or criminal, requested by the executive director of the department to abate a 
condition which exists in violation of, or to restrain or enjoin any action which is in 
violation of, or to prosecute for the violation of or for the enforcement of the public health 
laws or the standards, orders, rules, and regulations of the department established by or 
issued under the provisions of this part 1 . If the district attorney fails to act, the executive 
director may bring any such action and shall be represented by the attorney general or, with 
the approval of the board, by special counsel. 

Source: L. 47: p. 514, § 10. CSA: C. 78, § 21(11). CRS 53: § 66-1-12. C.R.S. 1963: 
§ 66-1-12. 

25-1-113. Judicial review of decisions. (1) Any person aggrieved and affected by a 
decision of the board or the executive director of the department is entitled to judicial 
review by filing in the district court of the county of his residence, or of the city and county 
of Denver, within ninety days after the public announcement of the decision, an appropriate 
action requesting such review. The court may make any interested person a party to the 
action. The review shall be conducted by the court without a jury and shall be confined to 
the record, if a complete record is presented; except that, in cases of alleged irregularities 
in the record or in the procedure before the board or the division of administration, 
testimony may be taken in the court. The court may affirm the decision or may reverse or 
modify it if the substantial rights of the appellant have been prejudiced as a result of the 
findings and decisions of the board being: Contrary to constitutional rights or privileges; or 
in excess of the statutory authority or jurisdiction of the board or the executive director of 
the department; or affected by any error of law; or made or promulgated upon unlawful 
procedure; or unsupported by substantial evidence in view of the entire record as submitted; 
or arbitrary or capricious. 

(2) Any party may have a review of the final judgment or decision of the district court 
by appellate review in accordance with law and the Colorado appellate rules. 

Source: L. 47:p. 514, § 11. CSA: C. 78, § 21(12). CRS 53: § 66-1-13. C.R.S. 1963: 
§ 66-1-13. 

ANNOTATION 

Claim of arbitrary refusal to grant license plumber's license although he has complied 

is cause of action. Petitioner states a cause of with all the requirements for the license. Grimm 

action under this section where he alleges that v. State Bd. of Health, 121 Colo. 269, 215 P.2d 

the state board of health has arbitrarily and 324 (1950). 

capriciously refused to grant him a master Action not controlled by C.R.C.P. 106. An 



25-1-114 



Health 



Title 25 - page 22 



action under this section is a statutory action and 
is not controlled by C.R.C.P. 106. Grimm v. 
State Bd. of Health, 121 Colo. 269, 215 P.2d 324 
(1950). 

Court may enter own judgment. Under this 
section, the court may enter what is more or less 
its judgment because provision is made for the 
court to modify the decision of the board if it so 
concludes. Grimm v. State Bd. of Health, 121 
Colo. 269, 215 P.2d 324 (1950). 

No review of failure to act. This section does 
not provide for judicial review of the depart- 



ment's failure to act. Nat'l Wildlife Fed'n v. 
Cotter Corp., 665 P.2d 598 (Colo. 1983). 

County is a "person aggrieved and af- 
fected" by decision of department of public 
health and environment concerning the issuance 
of a hazardous waste permit. Adams Bd. of 
County Comm'rs v. Colo. Dept. of Pub. Health 
& Env't, 218 P3d 336 (Colo. 2009). 

Applied in Stone Environmental Eng'r 
Servs., Inc. v. State Dept. of Health, 631 P2d 
1185 (Colo. App. 1981). 



25-1-114. Unlawful acts - penalties. (1 ) It is unlawful for any person, association, or 
corporation, and the officers thereof: 

(a) To willfully violate, disobey, or disregard the provisions of the public health laws 
or the terms of any lawful notice, order, standard, rule, or regulation issued pursuant thereto; 
or 

(b) To fail to make or file reports required by law or rule of the board relating to the 
existence of disease or other facts and statistics relating to the public health; or 

(c) To conduct any business or activity over which the department possesses the power 
to license and regulate without such license or permit as required by the department; or 

(d) To willfully and falsely make or alter any certificate or license or certified copy 
thereof issued pursuant to the public health laws; or 

(e) To knowingly transport or accept for transportation, interment, or other disposition 
a dead body without an accompanying permit issued in accordance with the public health 
laws or the rules of the board; or 

(f) To willfully fail to remove from private property under his control at his own 
expense, within forty-eight hours after being ordered so to do by the health authorities, any 
nuisance, source of filth, or cause of sickness within the jurisdiction and control of the 
department, whether such person, association, or corporation is the owner, tenant, or 
occupant of such private property; except that, if such condition is due to an act of God, it 
shall be removed at public expense; or 

(g) To pay, give, present, or otherwise convey to any officer or employee of the 
department any gift, remuneration, or other consideration, directly or indirectly, which such 
officer or employee is forbidden to receive by the provisions of this part 1 ; or 

(h) To make, install, maintain, or permit any cross-connection between any water 
system supplying drinking water to the public and any pipe, plumbing fixture, or water 
system which contains water of a quality below the minimum general sanitary standards as 
to the quality of drinking water supplied to the public or to fail to remove such connection 
within ten days after being ordered in writing by the department to remove the same. For 
the purposes of this paragraph (h), "cross-connection" means any connection which would 
allow water to flow from any pipe, plumbing fixture, or water system into a water system 
supplying drinking water to the public. 

(i) To sell or offer for sale any raw milk, milk product, or unsanitary dairy product, as 
defined in section 25-5.5-104, for other than human consumption unless it has first been 
treated with a dye approved by the department. 

(2) It is unlawful for any officer or employee of the department or member of the board 
to accept any gift, remuneration, or other consideration, directly or indirectly, for an 
incorrect or improper performance of the duties imposed upon him by or on behalf of the 
department. 

(3) It is unlawful: 

(a) For any officer or employee of the department to perform any work, labor, or 
services other than the duties assigned to him by or on behalf of the department during the 
hours such officer or employee is regularly employed by the department, or to perform his 
duties as an officer or employee of the department under any condition or arrangement that 
involves a violation of this or any other law of the state of Colorado; 



Title 25 - page 23 Administration 25- 1 - 1 1 4. 1 

(b) For any officer or employee of the department other than members of the board to 
perform any work, labor, or services which consist of the private practice of medicine, 
veterinary surgery, sanitary engineering, nursing, or any other profession which is or may 
be of special benefit to any private person, association, or corporation as distinguished from 
the department or the public generally, and which is performed by such officer or employee, 
directly or indirectly, for remuneration, whether done in an active, advisory, or consultative 
capacity or performed within or without the hours such officer or employee is regularly 
employed by the department. 

(4) Except as provided in subsection (5) of this section, any person, association, or 
corporation, or the officers thereof, who violates any provision of this section is guilty of 
a misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than 
one thousand dollars, or by imprisonment in the county jail for not more than one year, or 
by both such fine and imprisonment and, in addition to such fine and imprisonment, shall 
be liable for any expense incurred by health authorities in removing any nuisance, source 
of filth, or cause of sickness. Conviction under the penalty provisions of this part 1 or any 
other public health law shall not relieve any person from any civil action in damages that 
may exist for an injury resulting from any violation of the public health laws. 

(5) (a) It is unlawful for any person, association, or corporation, or the officers thereof, 
to tamper, attempt to tamper, or threaten to tamper with a public water system or with 
drinking water after its withdrawal for or treatment by a public water system. For purposes 
of this subsection (5), "tamper" means to introduce a contaminant into a public water 
system or into drinking water or to otherwise interfere with drinking water or the operation 
of a public water system with the intention of harming persons or the public water system. 
"Tamper" does not include the standardized and accepted treatment procedures performed 
by a supplier of water in preparing water for human consumption. 

(b) (I) Any person, association, or corporation, or the officers thereof, who tampers 
with a public water system or with drinking water after its withdrawal for or treatment by 
a public water system commits a class 3 felony and shall be punished as provided in section 
18-1.3-401, C.R.S. 

(II) Any person, association, or corporation, or the officers thereof, who attempts to 
tamper or threatens to tamper with a public water system or with drinking water after its 
withdrawal for or treatment by a public water system commits a class 5 felony and shall be 
punished as provided in section 18-1.3-401, C.R.S. 

(III) Conviction under this subsection (5) shall not relieve any person from a civil 
action initiated pursuant to section 25-1-114.1. 

Source: L. 47: p. 515, § 12. CSA: C. 78, § 21(13). CRS 53: § 66-1-14. C.R.S. 1963: 
§ 66-1-14. L. 64: p. 478, § 2. L. 75: (l)(i) added, p. 870, § 2, effective June 20. L. 86: 
(l)(i) amended, p. 1220, § 25, effective May 30. L. 87: (4) amended and (5) added, p. 610, 
§ 21, effective July 1. L. 2002: (5)(b)(I) and (5)(b)(II) amended, p. 1536, § 262, effective 
October 1. 

Cross references: For the legislative declaration contained in the 2002 act amending this section, 
see secfion 1 of chapter 318, Session Laws of Colorado 2002. 

25-1-114.1. Civil remedies and penalties. (1) The division of administration of the 
department may institute a civil action or administrative action, as described in subsection 
(2.5) of this section, against any person who violates a final enforcement order of the 
department issued for a violation of any minimum general sanitary standard or regulation 
adopted pursuant to section 25-1.5-202. Such civil action shall be brought in the district 
court of the county in which the violation of the standard or regulation is alleged to have 
occurred. 

(2) Upon finding that a final enforcement order of the department has been violated and 
that the violation of the standard or regulation described in the order in fact occurred, the 
court shall: 

(a) Impose a civil penalty on the violator of not more than one thousand dollars per day 
for each day the violation of the standard or regulation occurred if the court determines the 
violation was willful; or 



25-1-114.1 Health Title 25 - page 24 

(b) Enter such order as the public health may require, taking into consideration, where 
appropriate, the cost and time necessary to comply; or 

(c) Impose such civil penalty and enter such order. 

(2.5) (a) Any person who violates any minimum general sanitary standard and regu- 
lation promulgated pursuant to section 25-1.5-202 or 25-1-114 (1) (h), or any final 
enforcement order issued by the department, shall be subject to an administrative penalty 
as follows: 

(I) For systems that serve a population of more than ten thousand people, an amount not 
to exceed one thousand dollars per violation per day; or 

(II) For systems that serve a population of ten thousand people or less, an amount not 
to exceed one thousand dollars per violation per day, but only in an amount, as determined 
by the division, that is necessary to ensure compliance. 

(b) Penalties under this subsection (2.5) shall be determined by the executive director 
or the executive director's designee and may be collected by the division of administration 
by an action instituted in a court of competent jurisdiction for collection of such penalty. 
The final decision of the executive director or the executive director's designee may be 
appealed to the water quality control commission, created pursuant to section 25-8-201. A 
stay of any order of the division ending judicial review shall not relieve any person from 
any liability with respect to past or continuing violations of any minimum general sanitary 
standard or any regulation promulgated pursuant to section 25-1.5-202 or 25-1-114 (1) (h), 
but the reason for the request for judicial review shall be considered in the determination 
of the amount of the penalty. In the event that such an action is instituted for the collection 
of such penalty, the court may consider the appropriateness of the amount of the penalty, if 
such issue is raised by the party against whom the penalty was assessed. Any administrative 
penalty collected under this section shall be credited to the general fund. 

(3) The department may request the attorney general to bring a suit for a temporary 
restraining order or a preliminary or permanent injunction to prevent or abate any violation 
of a minimum general sanitary standard or regulation adopted pursuant to section 25-1.5- 
202 or to prevent or abate any release or imminent release that causes or is likely to cause 
contamination resulting in liability under section 25-1.5-207, and the department, in such a 
suit, may collect, on behalf of political subdivisions or public water systems, the damages 
incurred by such political subdivisions or public water systems under section 25-1.5-207. 
The department shall pay to such political subdivisions or public water systems all damages 
collected on their behalf. The department is not required to issue an enforcement order prior 
to institution of such a suit. Upon a de novo finding by the court that such a violation has 
occurred, is occurring, or is about to occur or that such release or imminent release exists, 
the court may enjoin such violation, release, or imminent release and enter such order as the 
public health may require, taking into consideration, where appropriate, the cost and time 
necessary to comply. An enforcement settlement with the state under the provisions of this 
subsection (3) shall bar a separate action by a political subdivision or public water system 
under section 25-1.5-207 whenever notice and adequate opportunity to comment on the 
proposed settlement have been given to the political subdivision or public water system, 
damages have been collected on behalf of and paid to such political subdivision or public 
water system by the state, and the release or imminent release has been prevented or abated 
by means of the settlement. 

(4) Suits brought pursuant to subsection (3) of this section shall be brought in the 
district court of the county in which the violation is alleged to have occurred. The institution 
of such a suit by the division of administration shall confer upon such court exclusive 
jurisdiction to determine finally the subject matter of the proceeding; except that the 
exclusive jurisdiction of the court shall apply only to such proceeding and shall not preclude 
assessment of any civil penalties or any other enforcement action or sanction authorized by 
this section. 

(4.5) An action for civil penalties under this section may be joined with a civil action 
to recover the state's costs pursuant to subsection (3) of this section. 

(5) The powers of the department established by this section shall be in addition to, and 
not in derogation of, any powers of the department. 



Title 25 - page 25 Administration 25-1-1 14.5 

(6) (a) The attorney general, at the request of the department, or the district attorney of 
the county in which an affected public water system is located or the attorney of the supplier 
of water may institute a civil action against any person, association, or corporation, or the 
officers thereof, who tampers, attempts to tamper, or threatens to tamper with a public water 
system or with drinking water after its withdrawal for or treatment by a public water system. 
Such action shall be brought in the district court of the county in which the violation is 
alleged to have occurred. As used in this subsection (6), "tamper" means to introduce a 
contaminant into a public water system or into drinking water or to otherwise interfere with 
drinking water or the operation of a public water system with the intention of harming 
persons or public water systems. "Tamper" does not include the standardized and accepted 
treatment procedures performed by a supplier of water in preparing water for human 
consumption. 

(b) Upon finding that tampering, attempting to tamper, or threatening to tamper has 
occurred, the court shall have the authority to: 

(I) Order appropriate injunctive relief; 

(II) Impose a civil penalty on the violator of not more than fifty thousand dollars for 
each act of tampering or of not more than twenty thousand dollars for each act of attempting 
to tamper or threatening to tamper; 

(III) Impose on the violator all costs incurred by the state and by the affected public 
water system in assessing and remedying all consequences of the tampering, attempting to 
tamper, or threatening to tamper; and 

(IV) Impose on the violator all court costs associated with remedying consequences of 
the tampering, attempting to tamper, or threatening to tamper. 

(7) Any person subject to an action brought pursuant to subsection (3) of this section 
or section 25-1.5-207 shall have an affirmative defense to such action if such person's 
potential liability results from a discharge of contaminants or substances authorized by and 
in substantial compliance with an existing federal or state permit which controls the quality 
of the release of the contaminant or substance. 

Source: L. 77: Entire section added, p. 1262, § 1, effective July 1. L. 83: (1) and (2) 
amended and (3) and (5) added, p. 1029, § 1, effective July 1. L. 87: (6) added, p. 610, 
§ 22, effective July 1. L. 88: (3) amended and (4.5) and (7) added, p. 996, § 3, effective 
May 11. L. 98: (1) amended and (2.5) added, p. 889, § 2, effective August 5. L. 2003: (1), 
IP(2.5)(a), (2.5)(b), (3), and (7) amended, p. 706, § 32, effective July 1. L. 2008: (2.5)(b) 
amended, p. 430, § 1, effective August 5. 

ANNOTATION 

Law reviews. For article, "Local Govern- "Local Governments and the Environment: Part 
ments and the Environment: Part I, CERCLA", II, RCRA", see 17 Colo. Law. 2159 (1988). 
see 17 Colo. Law. 1997 (1988). For article, 

25-1-114.5. Voluntary disclosure arising from self-evaluation - presumption 
against imposition of administrative or civil penalties. (1) For the purposes of this 
section, a disclosure of information by a person or entity to any division or agency within 
the department of public health and environment regarding any information related to an 
environmental law is voluntary if all of the following are true: 

(a) The disclosure is made promptly after knowledge of the information disclosed is 
obtained by the person or entity; 

(b) The disclosure arises out of a voluntary self-evaluation; 

(c) The person or entity making the disclosure initiates the appropriate effort to achieve 
compliance, pursues compliance with due diligence, and corrects the noncompliance within 
two years after the completion of the voluntary self-evaluation. Where such evidence shows 
the noncompliance is the failure to obtain a permit, appropriate efforts to correct the 
noncompliance may be demonstrated by the submittal of a complete permit application 
within a reasonable time. 

(d) The person or entity making the disclosure cooperates with the appropriate division 



25-1-114.5 Health Title 25 - page 26 

or agency in the department of public health and environment regarding investigation of the 
issues identified in the disclosure. 

(2) For the purposes of paragraph (c) of subsection ( 1 ) of this section, upon application 
to and at the discretion of the department of public health and environment, the time period 
within which the noncompliance is required to be corrected may be extended if it is not 
practicable to correct the noncompliance within the two-year period. A request for a de novo 
review of the decision of the department of public health and environment may be made to 
the appropriate district court or administrative law judge. 

(3) If a person or entity is required to make a disclosure to a division or agency within 
the department of public health and environment under a specific permit condition or under 
an order issued by the division or agency, then the disclosure is not voluntary with respect 
to that division or agency. 

(4) If any person or entity makes a voluntary disclosure of an environmental violation 
to a division or agency within the department of public health and environment, then there 
is a rebuttable presumption that the disclosure is voluntary and therefore the person or entity 
is immune from any administrative and civil penalties associated with the issues disclosed 
and is immune from any criminal penalties for negligent acts associated with the issues 
disclosed. The person or entity shall provide information supporting its claim that the 
disclosure is voluntary at the time that the disclosure is made to the division or agency. 

(5) To rebut the presumption that a disclosure is voluntary, the appropriate division or 
agency shall show to the satisfaction of the respective commission in the department of 
public health and environment or the state board of health, if no respective commission 
exists, that the disclosure was not voluntary based upon the factors set forth in subsections 
(1), (2), and (3) of this section. A decision by the commission or the state board of health, 
whichever is appropriate, regarding the voluntary nature of a disclosure is final agency 
action. The division or agency may not include any administrative or civil penalty or fine 
or any criminal penalty or fine for negligent acts in a notice of violation or in a 
cease-and-desist order on any underlying environmental violation that is alleged absent a 
finding by the respective commission or the state board of health that the division or agency 
has rebutted the presumption of voluntariness of the disclosure. The burden to rebut the 
presumption of voluntariness is on the division or agency. 

(6) The elimination of administrative, civil, or criminal penalties under this section 
does not apply if a person or entity has been found by a court or administrative law judge 
to have committed serious violations that constitute a pattern of continuous or repeated 
violations of environmental laws, rules, regulations, permit conditions, settlement agree- 
ments, or orders on consent and that were due to separate and distinct events giving rise to 
the violations, within the three-year period prior to the date of the disclosure. Such a pattern 
of continuous or repeated violations may also be demonstrated by multiple settlement 
agreements related to substantially the same alleged violations concerning serious instances 
of noncompliance with environmental laws that occurred within the three-year period 
immediately prior to the date of the voluntary disclosure. 

(7) Except as specifically provided in this section, this section does not affect any 
authority the department of public health and environment has to require any action 
associated with the information disclosed in any voluntary disclosure of an environmental 
violation. 

(8) Unless the context otherwise requires, the definitions contained in section 13-25- 
126.5 (2), C.R.S., apply to this section. 

(9) This section applies to voluntary disclosures that are made and voluntary self- 
evaluations that are performed on or after June 1, 1994. 

Source: L. 94: Entire section added, p. 1870, § 3, effective June 1; IP(1), (l)(d), (2), (3), 
(4), (5), and (7) amended, p. 2618, § 30, effective July 1. L. 99: (9) amended, p. 301, § 3, 
effective April 14. 

Cross references: For the legislative declaration contained in the 1994 act amending the intro- 
ductory portion to subsection (1) and subsections (l)(d), (2), (3), (4), (5), and (7), see section 1 of 
chapter 345, Session Laws of Colorado 1994. 



Title 25 - page 27 Administration 25- 1 - 1 1 4.6 

ANNOTATION 

Law reviews. For comment, "Colorado's En- New Hope for Colorado's Environmental Self- 

vironmental Audit Privilege Statute: Striking the Audit Law", see 30 Colo. Law. 71 (February 

Appropriate Balance?", see 67 U. Colo. L. Rev. 2001). 
443 (1996). For article, "Pilot Project Offers 

25-1-114.6. Implementation of environmental self-audit law - pilot project - legis- 
lative declaration. (1) (a) The general assembly hereby finds and determines that, in 
order to encourage the regulated community to utilize the environmental self-audit provi- 
sions contained in this section and sections 25-1-114.5, 13-25-126.5, and 13-90-107 (1) (j), 
C.R.S., a pilot project is established. The general assembly hereby declares that the purpose 
of the environmental self-audit provisions contained in this section and sections 25-1-114.5, 
13-25-126.5, and 13-90-107 (1) (j), C.R.S., is to encourage the regulated community to 
voluntarily identify environmental concerns and to address them expeditiously without fear 
of enforcement action by regulatory agencies. The general assembly recognizes that, due to 
concerns with the environmental self-audit provisions, the United States environmental 
protection agency has, in the past, taken direct action against entities in the regulated 
community that have made disclosures under the environmental self- audit provisions. The 
general assembly further declares that the pilot project enacted by this section is intended 
to allow entities to proceed under the environmental self-audit provisions with assurance 
that, if any such entity complies with such environmental self-audit provisions, the United 
States environmental protection agency will forego any enforcement action based on the 
disclosures made and addressed under the environmental self-audit pilot project. 

(b) The general assembly further recognizes that, under the pilot project enacted by this 
section, the department of public health and environment will have discretion to consider 
certain factors in assessing a regulated entity's eligibility for penalty immunity under the 
environmental laws. The general assembly intends that this additional flexibility to assess 
an entity's eligibility, along with the protection from federal overfiling that the pilot project 
provides, will encourage entities to participate in the project and allow the department of 
public health and environment to assess the effectiveness of the environmental self-audit 
provisions. 

(c) The provisions of this section shall only apply to disclosures made under this 
section and sections 25-1-114.5, 13-25-126.5, and 13-90-107 (1) (j), C.R.S., after the 
department of public health and environment and the United States environmental protec- 
tion agency have entered into a memorandum of agreement binding Colorado and the 
federal government to enforce environmental laws in a manner consistent with the provi- 
sions of this section. 

(2) Notwithstanding the provisions of sections 25- 1-114.5 (4) and (5), 1 3-25- 1 26.5, and 
13-90-107 (1) (j), C.R.S., on and after May 30, 2000, the department of public health and 
environment may assess penalties for criminal negligence when available under federal 
environmental law. 

(3) (a) In addition to the provisions of subsection (2) of this section, notwithstanding 
the provisions of sections 25-1-114.5 (4) and (5), 13-25-126.5, and 13-90-107 (1) (j), 
C.R.S., on and after May 30, 2000, in determining whether an entity is entitled to penalty 
immunity under the provisions of section 25-1-114.5, the department of public health and 
environment may consider: 

(I) Whether the activities disclosed may create imminent and substantial endangerment 
of, or result in serious harm to, public health and the environment; and 

(II) Whether the activities disclosed conferred an unfair or excessive economic benefit 
on the disclosing entity. 

(b) Notwithstanding any provision of sections 25-1-114.5 (4) and (5), 13-25-126.5, and 
13-90-107 (1) (j), C.R.S., the department of public health and environment has discretion 
to determine whether and to what degree the factors in paragraph (a) of this subsection (3) 
apply given the particular circumstances of each situation. 

(4) The pilot project created by this section applies to voluntary disclosures made under 
this section and sections 25-1-114.5, 13-25-126.5, and 13-90-107 (1) Q), C.R.S., on and 



25- 1 - 1 1 5 Health Title 25 - page 28 

after the effective dates of both this section (May 30, 2000) and the memorandum of 
agreement entered into under paragraph (c) of subsection ( 1 ) of this section. 

(5) Pursuant to the procedures set forth in section 13-25-126.5, C.R.S., the department 
of public health and environment may obtain access to an environmental self-audit report 
where the department of public health and environment has independent evidence of any 
criminal violation of an environmental law. Evidence of a criminal violation constitutes 
"compelling circumstances" for purposes of section 13-25-126.5 (3) (c), C.R.S., where the 
department of public health and environment seeks access to an environmental self-audit 
report. When a self-audit report is obtained, reviewed, or used in a criminal proceeding 
under this subsection (5), the privilege provided in section 13-25-126.5, C.R.S., applicable 
to civil or administrative proceedings is not waived or eliminated. 

(6) Repealed. 

Source: L. 2000: Entire section added, p. 1377, § 1, effective May 30. L. 2008: (6) 

repealed, p. 1906, § 98, effective August 5. 

25-1-115. Treatment - religious belief. Nothing in this part 1 shall authorize the 
department to impose any mode of treatment inconsistent with the religious faith or belief 
of any person. 

Source: L. 47: p. 517, § 15. CSA: C. 78, § 21(14). CRS 53: § 66-1-15. C.R.S. 1963: 
§ 66-1-15. 

25-1-116. Licensed healing systems not affected. Nothing in this part 1 shall be 
construed or used to amend or restrict any statute in force pertaining to the scope of practice 
of any state licensed healing system. 

Source: L. 47: p. 518, § 16. CSA: C. 78, § 21(15). CRS 53: § 66-1-16. C.R.S. 1963: 
§ 66-1-16. 

25-1-117. Acquisition of federal surplus property. The governor of the state of 
Colorado is authorized, for and on behalf of the state of Colorado, to make application for 
and secure the transfer to the state of Colorado of federal surplus property for the purpose 
of establishing state public health facilities in the state of Colorado; and to do and perform 
any acts and things which may be necessary to carry out the above, including the preparing, 
making, and filing of plans, applications, reports, and other documents, and the execution, 
acceptance, delivery, and recordation of agreements, deeds, and other instruments pertain- 
ing to the transfer of said property. The governor is further authorized to expend available 
general revenue funds, or such other funds as may be made available by the general 
assembly, for the purpose of making the above application and securing the transfer of said 
property in accordance with federal laws and with rules and regulations and requirements 
of the United States department of health, education, and welfare. 

Source: L. 59: p. 473, § 1. CRS 53: § 66-1-22. C.R.S. 1963: § 66-1-22. 

Cross references: For changes relating to the structure of the United States department of health, 
education, and welfare, see Public Law 96-88, Title III, section 301, and Title V, section 509, Oct. 17, 
1979, 93 Stat. 677, 695. 

25-1-118. Rental properties - salvage - fund created - repeal. (Repealed) 

Source: L. 60: p. 145, § 1. CRS 53: § 66-1-23. C.R.S. 1963: § 66-1-23. L. 94: (1) 
amended, p. 2701, § 253, effective July 1. L. 2008: Entire section amended, p. 1345, § 2, 
effective May 27. 



Title 25 - page 29 Administration 25-1-1 20 

Editor's note: Subsection (4) provided for the repeal of this section effective July 1, 2008. (See L. 
2008, p. 1345.) 

25-1-119. Disposition and expenditures of moneys from fund. (Repealed) 

Source: L. 60: p. 145, § 2. CRS 53: § 66-1-24. C.R.S. 1963: § 66-1-24. L. 94: 
(l)(a) amended, p. 2701, § 254, effective July 1. L. 2008: Entire section repealed, p. 1345, 
§ 3, effective May 27. 

25-1-120. Nursing facilities - rights of patients. ( 1 ) The department shall require all 
skilled nursing facilities and intermediate care facilities to adopt and make public a 
statement of the rights and responsibilities of the patients who are receiving treatment in 
such facilities and to treat their patients in accordance with the provisions of said statement. 
The statement shall ensure each patient the following: 

(a) The right to civil and religious liberties, including knowledge of available choices 
and the right to independent personal decisions, which will not be infringed upon, and the 
right to encouragement and assistance from the staff of the facility in the fullest possible 
exercise of these rights; 

(b) The right to have private and unrestricted communications with any person of his 
choice; 

(c) The right to present grievances on behalf of himself or others to the facility's staff 
or administrator, to governmental officials, or to any other person, without fear of reprisal, 
and to join with other patients or individuals within or outside of the facility to work for 
improvements in patient care; 

(d) The right to manage his own financial affairs or to have a quarterly accounting of 
any financial transactions made in his behalf, should he delegate such responsibility to the 
facility for any period of time; 

(e) The right to be fully informed, in writing, prior to or at the time of admission and 
during his stay, of services available in the facility and of related charges, including charges 
for services not covered under medicare or medicaid or not covered by the basic per diem 
rate; 

(f) The right to be adequately informed of his medical condition and proposed 
treatment, unless otherwise indicated by his physician, and to participate in the planning of 
all medical treatment, including the right to refuse medication and treatment, unless 
otherwise indicated by his physician, and to know the consequences of such actions; 

(g) The right to receive adequate and appropriate health care consistent with established 
and recognized practice standards within the community and with skilled and intermediate 
nursing care facility rules and regulations as promulgated by the department; 

(h) The right to have privacy in treatment and in caring for personal needs, confiden- 
tiality in the treatment of personal and medical records, and security in storing and using 
personal possessions; 

(i) The right to be treated courteously, fairly, and with the fullest measure of dignity and 
to receive a written statement of the services provided by the facility, including those 
required to be offered on an as-needed basis; 

(j) The right to be free from mental and physical abuse and from physical and chemical 
restraints, except those restraints initiated through the judgment of the professional staff for 
a specified and limited period of time or on the written authorization of a physician; 

(k) The right to be transferred or discharged only for medical reasons or his welfare, or 
that of other patients, or for nonpayment for his stay and the right to be given reasonable 
advance notice of any transfer or discharge, except in the case of an emergency as 
determined by the professional staff; 

(1) The right to devolution of his or her rights and responsibilities upon a sponsor, 
guardian, or person exercising rights contained in a designated beneficiary agreement 
executed pursuant to article 22 of title 15, C.R.S., who shall see that he or she is provided 
with adequate, appropriate, and respectful medical treatment and care and all rights which 
he or she is capable of exercising should he or she be determined to be incompetent 
pursuant to law and not be restored to legal capacity; 



25- 1-120 Health Title 25 - page 30 

(m) The right to freedom of choice in selecting a health care facility; 

(n) The right to copies of the facility's rules and regulations and an explanation of his 
responsibility to obey all reasonable rules and regulations of the facility and to respect the 
personal rights and private property of the other patients. 

(1.5) If a facility requires a lease agreement with a provision requiring in excess of a 
month-to-month tenancy and the lease agreement results in or requires forfeiture of more 
than thirty days of rent if a patient moves due to a medical condition or dies during the term 
of the lease agreement, then the lease agreement shall be deemed to be against public policy 
and shall be void; except that inclusion of such a provision shall not render the remainder 
of the contract or lease agreement void. A contract provision or lease agreement that 
requires forfeiture of rent for thirty days after the patient moves due to a medical condition 
or dies does not violate this section. The provisions regarding forfeiture of rent shall appear 
on the front page of the contract or lease agreement and shall be printed in no less than 
twelve-point bold-faced type. The provisions shall read as follows: 

This lease agreement is for a month-to-month tenancy. The lessor shall not 
require the forfeiture of rent beyond a thirty-day period if the lessee moves 
due to a medical condition or dies during the term of the lease. 

In circumstances in which the patient moves due to a medical condition or dies during the 
term of a contract or lease agreement, the facility shall return that part of the rent paid in 
excess of thirty days' rent after a patient moves or dies to the patient or the patient's estate. 
The facility may assess daily rental charges for any days in which the former or deceased 
patient's personal possessions remain in the patient's room after the period for which the 
patient has paid rent and for the usual time to clean the room after the patient's personal 
possessions have been removed. The facility shall have forty-five days after the date the 
patient's personal possessions have been removed from the patient's room to reconcile the 
patient's accounts and to return any moneys owed. This subsection (1.5) applies to any 
facility, or a distinct part of a facility, that meets the state nursing home licensing standards 
set forth in section 25-1.5-103 (1) (a) (I) and the licensing requirements specified in section 
25-3-101. For purposes of this section, "daily rental charges" means an amount not to 
exceed one-thirtieth of thirty days' rental amount plus reasonable expenses. 

(2) Each skilled nursing facility or intermediate care facility shall provide a copy of the 
statement required by subsection (1) of this section to each patient or his guardian at or 
before the patient's admission to a facility and to each staff member of a facility. Each such 
facility shall prepare a written plan and provide appropriate staff training to implement the 
provisions of this section. 

(3) Each skilled nursing facility or intermediate care facility shall prepare a written plan 
and provide appropriate facilities to ensure that the rights guaranteed by subsection (1) of 
this section are enforced by a grievance procedure which contains the following procedures 
and rights: 

(a) A resident of any facihty, the residents' advisory council, or the sibling, child, 
spouse, parent, or person exercising rights contained in a designated beneficiary agreement 
executed pursuant to article 22 of title 15, C.R.S., of any resident may formally complain 
in the manner described in this subsection (3) about any conditions, treatment, or violations 
of his or her rights by the facility or its staff or about any treatment, conditions, or violations 
of the rights of any other resident, regardless of the consent of the victim of the alleged 
improper treatment, condition, or violation of rights by the facility or its staff. 

(b) Each facility shall designate one full-time staff member, referred to in this subsec- 
tion (3) as the "designee", to receive all grievances when they are first made. 

(c) Each facility shall establish a grievance committee consisting of the chief admin- 
istrator of the facility or his designee, a resident selected by the resident population of the 
facility, and a third person to be agreed upon by the administrator and the resident 
representative. 

(d) If anyone designated in paragraph (a) of this subsection (3) wishes to complain 
about treatment, conditions, or violations of rights, he shall write or cause to be written his 
grievance or shall state it orally to the designee no later than fourteen days after the 



Title 25 - page 3 1 Administration 25-1-1 20 

occurrence giving rise to the grievance. The designee shall confer with persons involved in 
the occurrence and with any other witnesses and, no later than three days after the 
grievance, give a written explanation of findings and proposed remedies, if any, to the 
complainant and to the aggrieved party, if someone other than the complainant. Where 
appropriate because of the mental or physical condition of the complainant or the aggrieved 
party, the written explanation shall be accompanied by an oral explanation. 

(e) If the complainant or aggrieved party is dissatisfied with the findings and remedies 
or the implementation thereof, he may then make the same grievance orally or in writing, 
with any additional comments or information, to the grievance committee no later than ten 
days after the receipt of the explanation from the designee. Said committee shall confer with 
persons involved in the occurrence and with any other witnesses and, no later than ten days 
after the appeal from the designee, give a written explanation of its findings and proposed 
remedies, if any, to the complainant and to the aggrieved party, if someone other than the 
complainant. Where appropriate because of the mental or physical condition of the 
complainant or the aggrieved party, the written explanation shall be accompanied by an oral 
explanation. 

(4) Each skilled nursing facility or intermediate care facility shall also establish a 
residents' advisory council which shall consist of not less than five members selected by 
and from the resident population of the facility. The council shall meet at least once a month 
with the administrator of the facility and a representative of the staff to make recommen- 
dations concerning policies of the facility. The council may also present grievances to the 
grievance committee on behalf of a resident. 

(5) If a complainant or aggrieved party is dissatisfied with the findings and remedies of 
the grievance committee or implementation thereof, except for grievances against a 
physician or his prescribed treatment, he may file the same grievance in writing with the 
executive director of the department. The department shall investigate the facts and 
circumstances of the grievance and make findings of fact, conclusions, and recommenda- 
tions, copies of which shall be transmitted to the complainant and the nursing home 
administrator. If the complainant or the nursing home administrator is aggrieved by the 
findings and the recommendations of the department, the aggrieved party may request a 
hearing to be conducted by the department pursuant to section 24-4-105, C.R.S. The board 
shall adopt rules and regulations to carry out the intent of this section. 

(6) Implementation of this section shall be pursuant to section 25.5-6-204, C.R.S. 

(7) Nothing in this section shall apply to any nursing institution conducted by or for the 
adherents of any well-recognized church or religious denomination for the purpose of 
providing facilities for the care and treatment of the sick who depend exclusively upon 
spiritual means through prayer for healing in the practice of the religion of such church or 
denomination. 

(8) (a) A patient who is eligible to receive medicaid benefits pursuant to articles 4, 5, 
and 6 of title 25.5, C.R.S., and who qualifies for nursing facility care shall have the right 
to select any nursing care facility recommended for certification by the department of public 
health and environment under Title XIX of the federal "Social Security Act", as amended, 
as a provider of medicaid services and licensed by the department pursuant to article 3 of 
this title where space is available, and the department of health care policy and financing 
shall reimburse the selected facility for services pursuant to section 25.5-6-204, C.R.S., 
unless such nursing care facility shall have been notified by the department of health care 
policy and financing that it may not qualify as a provider of medicaid services. 

(b) A patient who is residing in such nursing care facility shall be assured the resident 
rights which are provided by section 4211 of Title IV of the federal "Omnibus Budget 
Reconciliation Act of 1987", as amended, Pub.L. 100-203. Failure to protect and promote 
those rights shall subject the violating facility to sanctions imposed by the department. 

(9) A patient who is eligible to receive benefits from a skilled or intermediate nursing 
care facility certified by the department under Title XVIII of the federal "Social Security 
Act", as amended, as a provider of medicare services shall be assured the same rights as 
provided in paragraph (a) of subsection (8) of this section. 

Source: L. 75: Entire section added, p. 873, § 1, effective July 1. L. 76: (8) added, p. 
640, § 1, effective May 26. L. 89: (3)(a) and (8) amended and (9) added, p. 1144, § 1, 



25- 1 - 1 2 1 Health Title 25 - page 32 

effective April 4. L. 91: (6) and (8)(a) amended, p. 1856, § 13, effective April 11. L. 94: 
(8)(a) amended, p. 2624, § 42, effective July 1. L. 2006: (6) and (8)(a) amended, p. 2012, 
§ 81, effective July 1; (1.5) added, p. 253, § 1, effective January 1, 2007. L. 2009: (1)(1) 
and (3)(a) amended, (HB 09-1260), ch. 107, p. 448, § 18, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(8)(a), see section 1 of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 

Law reviews. For article, "Advocating for tion. Macleod v. Miller, 44 Colo. App. 313, 612 

Quality Nursing Home Care and Sufficient P.2d 1158 (1980). 

Staffing in Colorado", see 34 Colo. Law. 31 Burden is on nursing facility to show that 

(October 2005). For article, "Involuntary Dis- the transfer is in accordance with subsections 

charge From Nursing Homes", see 34 Colo. (l)(k) and (8). Macleod v. Miller, 44 Colo. App. 

Law. 37 (October 2005). 313, 612 P.2d 1158 (1980). 

Substantive and due process rights of nurs- 
ing home patients are established by this sec- 

25-1-121. Patient grievance mechanism - institution's obligations to patient. 

(1) As used in this section, "institution" means every hospital or related facility or 
institution having in excess of fifty beds and required to be licensed under part 1 of article 
3 of this title or required to be certified pursuant to section 25-1.5-103 (1) (a) (II), except 
skilled nursing facilities and intermediate care facilities which are subject to the provisions 
of section 25-1-120. 

(2) The department shall require every institution to submit to the department a plan for 
a patient grievance mechanism and a policy statement with respect to the obligations of the 
institution to patients using the facilities of such institution. The plan and policy statement 
must meet with the approval of the department prior to certification of compliance or 
issuance or renewal of a license. 

(3) A patient grievance mechanism plan shall include, but not be limited to: 

(a) A provision for a patient representative to serve as a liaison between the patient and 
the institution; 

(b) A description of the qualifications of the patient representative; 

(c) An outline of the job description of the patient representative; 

(d) A description of the amount of decision-making authority given to the patient 
representative; 

(e) A method by which each patient will be made aware of the patient representative 
program and how the representative of the program may be contacted. 

(4) The policy statement with respect to the obligations of the institution to patients 
using facilities of such an institution shall be posted conspicuously in a public place on its 
premises and made available to each patient upon admission. Such policy statement shall 
include, but need not be limited to, a clarification of a physician's duty to provide informed 
consent, admission procedures, staff identification, privacy, medical records, billing proce- 
dures, and the obligation of the physician to provide information regarding research, 
experimental, or educational projects relating to the patient's own case. Nothing in this 
section shall apply to any nursing institution conducted by or for the adherents of any 
well-recognized church or religious denomination for the purpose of providing facilities for 
the care and treatment of the sick who depend exclusively upon spiritual means through 
prayer for healing in the practice of the religion of such church or denomination. 

Source: L. 76: Entire section added, p. 640, § 2, effective May 26. L. 2003: (1) 

amended, p. 708, § 33, effective July 1. 

25-1-122. Named reporting of certain diseases and conditions - access to medical 
records - confidentiality of reports and records. (1) With respect to investigations of 
epidemic and communicable diseases, morbidity and mortality, cancer in connection with 



Title 25 - page 33 Administration 25-1-122 

the statewide cancer registry, environmental and chronic diseases, sexually transmitted 
infections, tuberculosis, and rabies and mammal bites, the board has the authority to require 
reporting, without patient consent, of occurrences of those diseases and conditions by any 
person having knowledge of such to the state department of public health and environment 
and county, district, and municipal public health agencies, within their respective jurisdic- 
tions. Any required reports shall contain the name, address, age, sex, and diagnosis and such 
other relevant information as the board determines is necessary to protect the public health. 
The board shall set the manner, time period, and form in which such reports are to be made. 
The board may limit reporting for a specific disease or condition to a particular region or 
community or for a limited period of time. Nothing in this subsection (1) shall be construed 
to apply to cases of AIDS, HIV-related illness, or HIV infection, which shall be governed 
solely by the reporting requirements set forth in part 14 of article 4 of this title. 

(2) When investigating diseases and conditions pursuant to subsection (1) of this 
section, authorized personnel of the state department of public health and environment and 
county, district, and municipal public health agencies, within their respective jurisdictions, 
may, without patient consent, inspect, have access to, and obtain information from pertinent 
patient medical, coroner, and laboratory records in the custody of all medical practitioners, 
veterinarians, coroners, institutions, hospitals, agencies, laboratories, and clinics, whether 
public or private, which are relevant and necessary to the investigation. Review and 
inspection of records shall be conducted at reasonable times and with such notice as is 
reasonable under the circumstances. Under no circumstances may personnel of the state 
department of public health and environment or county, district, or municipal public health 
agencies, within their local jurisdictions, have access pursuant to this section to any medical 
record that is not pertinent, relevant, or necessary to the public health investigation. Nothing 
in this subsection (2) shall be construed to apply to cases of AIDS, HIV-related illness, or 
HIV infection, which shall be governed solely by the requirements relating to access to 
records and the release of information as set forth in part 14 of article 4 of this title. 

(3) Any report or disclosure made in good faith pursuant to subsection (1) or (2) of this 
section shall not constitute libel or slander or a violation of any right of privacy or 
privileged communication. 

(4) Reports and records resulting from the investigation of epidemic and communicable 
diseases, environmental and chronic diseases, reports of morbidity and mortality, reports of 
cancer in connection with the statewide cancer registry, and reports and records resulting 
from the investigation of sexually transmitted infections, tuberculosis, and rabies and 
mammal bites held by the state department of public health and environment or county, 
district, or municipal public health agencies shall be strictly confidential. Such reports and 
records shall not be released, shared with any agency or institution, or made public, upon 
subpoena, search warrant, discovery proceedings, or otherwise, except under any of the 
following circumstances: 

(a) Release may be made of medical and epidemiological information in a manner such 
that no individual person can be identified. 

(b) Release may be made of medical and epidemiological information to the extent 
necessary for the treatment, control, investigation, and prevention of diseases and condi- 
tions dangerous to the public health; except that every effort shall be made to limit 
disclosure of personal identifying information to the minimal amount necessary to accom- 
plish the public health purpose. 

(c) Release may be made to the person who is the subject of a medical record or report 
with written authorization from such person. 

(d) An officer or employee of the county, district, or municipal public health agency or 
the state department of public health and environment may make a report of child abuse to 
agencies responsible for receiving or investigating reports of child abuse or neglect in 
accordance with the applicable provisions of the "Child Protection Act of 1987" set forth 
in part 3 of article 3 of title 19, C.R.S. However, in the event a report is made by the state 
department of public health and environment, only the following information shall be 
included in the report: 

(I) The name, address, and sex of the child; 

(II) The name and address of the person responsible for the child; 



25- 1 - 1 22.5 Health Title 25 - page 34 

(III) The name and address of the person who is alleged to be responsible for the 
suspected abuse or neglect, if known; and 

(IV) The general nature of the child's injury. 

(e) Medical and epidemiological information may be released to a peace officer as 
described in section 16-2.5-101, C.R.S., the federal bureau of investigation, a federal law 
enforcement agency as designated by the United States attorney for the district of Colorado, 
or any prosecutor to the extent necessary for any investigation or prosecution related to 
bioterrorism; except that reasonable efforts shall be made to limit disclosure of personal 
identifying information to the minimal amount necessary to accomplish the law enforce- 
ment purpose. For purposes of this paragraph (e), "bioterrorism" means the intentional use 
of, attempted use of, conspiracy to use, or solicitation to use microorganisms or toxins of 
biological origin or chemical or radiological agents to cause death or disease among humans 
or animals. 

(5) No officer or employee or agent of the state department of public health and 
environment or county, district, or municipal public health agency shall be examined in any 
judicial, executive, legislative, or other proceeding as to the existence or content of any 
individual's report obtained by such department pursuant to subsection (1) or (2) of this 
section without that individual's consent. However, this provision shall not apply to 
individuals who are under isolation or quarantine, school exclusion, or other restrictive 
action taken pursuant to section 25-1.5-102 (1) (c) or part 4, 5, 6, or 9 of article 4 of this 
title. 

(6) Any officer or employee or agent of the state department of public health and 
environment or a county, district, or municipal public health agency who violates this 
section by releasing or making public confidential public health reports or records or by 
otherwise breaching the confidentiality requirements of subsection (4) or (5) of this section 
commits a class 1 misdemeanor and, upon conviction thereof, shall be punished as provided 
in section 18-1.3-501 (1), C.R.S. 

(7) Nothing in subsections (4) to (6) of this section shall apply to records and reports 
held by the state or local department of health pursuant to part 14 of article 4 of this title. 

(8) Pursuant to section 25-1-113, any person may seek judicial review of a decision of 
the board or of the department affecting such person under this section. 

(9) Notwithstanding any other provision of law to the contrary, the department shall 
administer the provisions of this section regardless of an individual's race, religion, gender, 
ethnicity, national origin, or immigration status. 

Source: L. 91: Entire section added, p. 943, § 2, effective May 6. L. 93: (4)(d) added, 
p. 1609, § 3, effective June 6. L. 94: (2), IP(4), IP(4)(d), (5), and (6) amended, p. 2741, 
§ 378, effective July 1. L. 2002: (6) amended, p. 1536, § 263, effective October 1. 
L. 2003: (4)(e) added, p. 1020, § 1, effective April 17; (5) amended, p. 708, § 34, effective 
July 1. L. 2004: (4)(e) amended, p. 1201, § 65, effective August 4. L. 2006, 1st Ex. Sess.: 
(9) added, p. 25, § 1, effective July 31. L. 2009: (1) and IP(4) amended, (SB 09-179), ch. 
112, p. 474, § 19, effective April 9. L. 2010: (1), (2), IP(4), IP(4)(d), (5), and (6) amended, 
(HB 10-1422), ch. 419, p. 2090, § 84, effective August 11. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(2), the introductory portions to subsections (4) and (4)(d), and subsections (5) and (6), see section 1 
of chapter 345, Session Laws of Colorado 1994. For the legislative declaration contained in the 2002 
act amending this section, see section 1 of chapter 318, Session Laws of Colorado 2002. 

ANNOTATION 

Law reviews. For article, "2006 Immigrafion 
Legislafion in Colorado", see 35 Colo. Law. 79 
(October 2006). 

25-1-122.5. Confidentiality of genetic testing records - "Uniform Parentage Act". 

Notwithstanding any other law concerning public records, any records or information 



Title 25 - page 35 Administration 25- 1 - 1 24 

concerning the genetic testing of a person for purposes of the determination of parentage 
pursuant to article 4 of tide 19, C.R.S., shall be confidential and shall not be disclosed 
except as otherwise provided in section 19-1-308, C.R.S. 

Source: L. 94: Entire section added, p. 1549, § 28, effective May 31. L. 96: Entire 
section amended, p. 1175, § 14, effective January 1, 1997. 

25-1-123. Restructure of health and human services - development of plan - 
participation of department required. The department, in cooperation with the depart- 
ment of health care policy and financing and the department of human services, shall 
develop a plan for the restructuring of the health and human services delivery system in the 
state in accordance with article 1.7 of title 24, C.R.S. 

Source: L. 93: Entire section added, p. 1097, § 14, effective July 1, 1994. 

Cross references: For the legislative declaration contained in the 1993 act enacting this section, see 
section 1 of chapter 230, Session Laws of Colorado 1993. 

25-1-124. Health care facilities - consumer information - reporting - release. 

(1) The general assembly hereby finds that an increasing number of people are faced with 
the difficult task of choosing a health care facility for themselves and their family members. 
This task may be made less difficult by improved access to reliable, helpful, and unbiased 
information concerning the quality of care and the safety of the environment offered by each 
health care facility. The general assembly further finds that it is appropriate that the 
department, in keeping with its role of protecting and improving the public health, solicit 
this information from health care facilities and disseminate it to the public in a form that 
will assist people in making informed choices among health care facilities. 

(2) Each health care facility licensed pursuant to section 25-3-101 or certified pursuant 
to section 25-1.5-103 (1) (a) (II) shall report to the department all of the following 
occurrences: 

(a) Any occurrence that results in the death of a patient or resident of the facility and 
is required to be reported to the coroner pursuant to section 30-10-606, C.R.S., as arising 
from an unexplained cause or under suspicious circumstances; 

(b) Any occurrence that results in any of the following serious injuries to a patient or 
resident: 

(I) Brain or spinal cord injuries; 

(II) Life-threatening complications of anesthesia or life-threatening transfusion errors 
or reactions; 

(III) Second- or third-degree burns involving twenty percent or more of the body 
surface area of an adult patient or resident or fifteen percent or more of the body surface 
area of a child patient or resident; 

(c) Any time that a resident or patient of the facility cannot be located following a 
search of the facility, the facility grounds, and the area surrounding the facility and there are 
circumstances that place the resident's health, safety, or welfare at risk or, regardless of 
whether such circumstances exist, the patient or resident has been missing for eight hours; 

(d) Any occurrence involving physical, sexual, or verbal abuse of a patient or resident, 
as described in section 18-3-202, 18-3-203, 18-3-204, 18-3-206, 18-3-402, 18-3-403, as it 
existed prior to July 1, 2000, 18-3-404, or 18-3-405, C.R.S., by another patient or resident, 
an employee of the facility, or a visitor to the facility; 

(e) Any occurrence involving neglect of a patient or resident, as described in section 
26-3.1-101 (4) (b), C.R.S.; 

(f) Any occurrence involving misappropriation of a patient's or resident's property. For 
purposes of this paragraph (f), "misappropriation of a patient's or resident's property" 
means a pattern of or deliberately misplacing, exploiting, or wrongfully using, either 
temporarily or permanently, a patient's or resident's belongings or money without the 
patient's or resident's consent. 



25- 1 - 1 24 Health Title 25 - page 36 

(g) Any occurrence in which drugs intended for use by patients or residents are diverted 
to use by other persons. If the diverted drugs are injectable, the health care facility shall also 
report the full name and date of birth of any individual who diverted the injectable drugs, 
if known. 

(h) Any occurrence involving the malfunction or intentional or accidental misuse of 
patient or resident care equipment that occurs during treatment or diagnosis of a patient or 
resident and that significantly adversely affects or if not averted would have significantly 
adversely affected a patient or resident of the facility. 

(2.5) (a) In addition to the reports required by subsection (2) of this section, if the 
Colorado attorney general, the division for developmental disabilities in the department of 
human services, a community centered board, an adult protection service, or a law 
enforcement agency makes a report of an occurrence as described in subsection (2) of this 
section involving a licensed long-term care facility, that report shall be provided to the 
department and shall be made available for inspection consistent with the provisions of 
subsection (6) of this section. Any reports concerning an adult protection service shall be 
in compliance with the confidentiality requirements of section 26-3.1-102 (7), C.R.S. 

(b) For purposes of this subsection (2.5), a "licensed long-term care facility" means a 
licensed community residential or group home, a licensed intermediate care facility for the 
mentally retarded, and a licensed facility for persons with developmental disabilities. 

(3) The board by rule shall specify the manner, time period, and form in which the 
reports required pursuant to subsection (2) of this section shall be made. 

(4) Any report submitted pursuant to subsection (2) of this section shall be strictly 
confidential; except that information in any such report may be transmitted to an appropriate 
regulatory agency having jurisdiction for disciplinary or license sanctions. The information 
in such reports shall not be made public upon subpoena, search warrant, discovery 
proceedings, or otherwise, except as provided in subsection (6) of this section. 

(5) The department shall investigate each report submitted pursuant to subsection (2) of 
this section that it determines was appropriately submitted. For each report investigated, the 
department shall prepare a summary of its findings, including the department's conclusions 
and whether there was a violation of licensing standards or a deficiency or whether the 
facility acted appropriately in response to the occurrence. If the investigation is not 
conducted on site, the department shall specify in the summary how the investigation was 
conducted. Any investigation conducted pursuant to this subsection (5) shall be in addition 
to and not in lieu of any inspection required to be conducted pursuant to section 25-1.5-103 
(1) (a) with regard to licensing. 

(6) (a) The department shall make the following information available to the public: 

(I) Any investigation summaries prepared pursuant to subsection (5) of this section; 

(II) Any complaints against a health care facility that have been filed with the 
department and that the department has investigated, including the conclusions reached by 
the department and whether there was a violation of licensing standards or a deficiency or 
whether the facility acted appropriately in response to the subject of the complaint; and 

(III) A listing of any deficiency citations issued against each health care facility. 

(b) The information released pursuant to this subsection (6) shall not identify the 
patient or resident or the health care professional involved in the report. 

(7) Prior to the completion of an investigation pursuant to this section, the department 
may respond to any inquiry regarding a report received pursuant to subsection (2) of this 
section by confirming that it has received such report and that an investigation is pending. 

(8) In addition to the report to the department for an occurrence described in paragraph 
(d) of subsection (2) of this section, the occurrence shall be reported to a law enforcement 
agency. 

Source: L. 97: Entire section added, p. 504, § 1, effective April 24. L. 2000: (2)(d) 
amended, p. 708, § 37, effective July 1. L. 2003: IP(2) and (5) amended, p. 708, § 35, 
effective July 1. L. 2006: (2.5) and (8) added, p. 349, § 1, effective April 6. L. 2010: IP(2) 
and (2)(g) amended, (HB 10-1414), ch. 338, p. 1552, § 1, effective June 5. 



Title 25 - page 37 Administration 25-1-125 

Cross references: For limitation on liability regarding transplants and transfusion of blood, see 
§ 13-22-104. 

25-1-124.5. Nursing care facilities - employees - criminal history check. (1) On 

and after September 1, 1996, prior to employing any person, a nursing care facility or the 
person seeking employment at a nursing care facility shall make an inquiry to the director 
of the Colorado bureau of investigation or to private criminal background check companies 
authorized to do business in the state of Colorado to ascertain whether such person has a 
criminal history, including arrest and conviction records. The Colorado bureau of investi- 
gation or private criminal background check companies are authorized to utilize fingerprints 
to ascertain from the federal bureau of investigation whether such person has a criminal 
history record. The nursing care facility or the person seeking employment in a nursing care 
facility shall pay the costs of such inquiry. The criminal history check shall be conducted 
not more than ninety days prior to the employment of the applicant. For purposes of this 
section, criminal background check companies shall be approved by the state board of 
nursing. In approving such companies, approval shall be based upon the provision of 
lawfully available, accurate, and thorough information pertaining to criminal histories, 
including arrest and conviction records. 

(2) As used in this section, "nursing care facility" includes, but is not limited to: 

(a) A nursing facility as defined in section 25.5-4-103 (14), C.R.S.; 

(b) An intermediate nursing facility for the mentally retarded as defined in section 
25.5-4-103 (9), C.R.S.; 

(c) An adult day care facility as defined in section 25.5-6-303 (1), C.R.S.; 

(d) An alternative care facility as defined in section 25.5-6-303 (3), C.R.S.; 

(e) Any business that provides temporary nursing care services or that provides 
personnel who provide such services. 

Source: L. 2002: Entire section added, p. 1180, § 3, effective July 1. L. 2006: (2)(a) to 
(2)(d) amended, p. 2013, § 82, effective July 1. 

25-1-125. Applications for licenses - authority to suspend licenses - rules. (1) Ev- 
ery application by an individual for a license issued by the department or any authorized 
agent of the department shall require the applicant's name, address, and social security 
number. 

(2) The department or any authorized agent of the department shall deny, suspend, or 
revoke any license pursuant to the provisions of section 26-13-126, C.R.S., and any rules 
promulgated in furtherance thereof, if the department or agent thereof receives a notice to 
deny, suspend, or revoke from the state child support enforcement agency because the 
licensee or applicant is out of compliance with a court or administrative order for current 
child support, child support debt, retroactive child support, child support arrearages, or child 
support when combined with maintenance or because the licensee or applicant has failed to 
comply with a properly issued subpoena or warrant relating to a paternity or child support 
proceeding. Any such denial, suspension, or revocation shall be in accordance with the 
procedures specified by rule of the department, rules promulgated by the state board of 
human services, and any memorandum of understanding entered into between the depart- 
ment or an authorized agent thereof and the state child support enforcement agency for the 
implementation of this section and section 26-13-126, C.R.S. 

(3) (a) The department shall enter into a memorandum of understanding with the state 
child support enforcement agency, which memorandum shall identify the relative respon- 
sibilities of the department and the state child support enforcement agency in the depart- 
ment of human services with respect, to the implementation of this section and section 
26-13-126, C.R.S. 

(b) The appropriate rule-making body of the department is authorized to promulgate 
rules to implement the provisions of this section. 

(4) For purposes of this section, "license" means any recognition, authority, or 
permission that the department or any authorized agent of the department is authorized by 
law to issue for an individual to practice a profession or occupation or for an individual to 



25-1-126 Health Title 25 - page 38 

participate in any recreational activity. "License" may include, but is not necessarily 
limited to, any license, certificate, certification, letter of authorization, or registration issued 
for an individual to practice a profession or occupation or for an individual to participate in 
any recreational activity. 

Source: L. 97: Entire section added, p. 1285, § 28, effective July 1. 

Cross references: For the legislative declarafion contained in the 1997 act enacting this section, see 
section 51 of chapter 236, Session Laws of Colorado 1997. 

25-1-126. County practitioner rural recruitment grant program - creation - leg- 
islative declaration - administration - report - definitions - repeal. (Repealed) 

Source: L. 2007: Entire section added, p. 2093, § 3, effective July 1, 2008. 

Editor's note: Subsection (6) provided for the repeal of this section, effecUve July 1, 2010. (See 
L. 2007, p. 2093.) 

25-1-127. Medical equipment for rural communities grant program - creation - 
legislative declaration - administration - report - repeal. (Repealed) 

Source: L. 2007: Entire section added, p. 2093, § 3, effective July 1, 2008. 

Editor's note: Subsecfion (6) provided for the repeal of this section, effecfive July 1, 2010. (See 
L. 2007, p. 2093.) 

PART 2 

ALCOHOL AND DRUG ABUSE 

25-1-201 to 25-1-217. (Repealed) 

Source: L. 2010: Entire part repealed, (SB 10-175), ch. 188, p. 675, § 1, effective April 
29. 

Editor's note: (1) This part 2 was numbered as article 36 of chapter 66, C.R.S. 1963. For 
amendments to this part 2 prior to its repeal in 2010, consult the Colorado statutory research 
explanatory note and the table itemizing the replacement volumes and supplements to the original 
volume of C.R.S. 1973 beginning on page vii in the front of this volume. 

(2) The provisions of this part 2 were relocated to article 80 of title 27 in 2010. 

(3) Section 25-1-201 (4) was amended by House Bill 10-1422 and section 25-1-217 (3)(a) was 
amended by House Bill 10-1347. Said bills were harmonized with Senate Bill 10-175 and relocated 
to secdons 27-80-101 and 27-80-117, respectively. 

PART 3 

ALCOHOLISM AND INTOXICATION TREATMENT 

25-1-301 to 25-1-316. (Repealed) 

Source: L. 2010: Entire part repealed, (SB 10-175), ch. 188, p. 675, § 1, effective April 
29. 

Editor's note: (1) This part 3 was numbered as article 45 of chapter 66, C.R.S. 1963. For 
amendments to this part 3 prior to its repeal in 2010, consult the Colorado statutory research 



Title 25 - page 39 Administration 25- 1 -404 

explanatory note and the table itemizing the replacement volumes and supplements to the original 
volume of C.R.S. 1973 beginning on page vii in the front of this volume. 

(2) The provisions of this part 3 were relocated to article 81 of title 27 in 2010. 

PART 4 

STATE CHEMIST 

25-1-401. Office of state chemist created. The professor of food and drug chemistry 
in the department of chemistry at the university of Colorado shall be the state chemist of 
Colorado. The office and laboratory of the state chemist shall be in the department of 
chemistry at the university of Colorado. The office of state chemist shall be a section of the 
division of administration of the department of public health and environment. 

Source: L. 39: p. 550, § 1. CSA: C. 78, § 25(1). CRS 53: § 66-16-1. C.R.S. 1963: 

§ 66-16-1. L. 68: p. 107, § 78. L. 94: Entire section amended, p. 2742, § 380, effective 
July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-1-402. Employment of assistants. The state chemist has the power to employ such 
assistants as are necessary for the carrying out of this part 4. The appropriations for the 
office of state chemist shall be determined by each general assembly in the general 
appropriation bill. The state chemist and his assistant shall also be reimbursed for all 
legitimate and necessary expenses incurred in the performance of the duties of the office of 
state chemist. 

Source: L. 39: p. 550, § 2. CSA: C. 78, § 25(2). CRS 53: § 66-16-2. C.R.S. 1963: 

§ 66-16-2. 

25-1-403. Analyses of food and drugs. It is the duty of the state chemist to make or 
cause to be made chemical analyses of all such samples of foods and drugs as may be 
collected for the purpose of analysis by the department of public health and environment. 
The state chemist shall make full and complete written reports, without unnecessary delay, 
of such analyses to the department of public health and environment. 

Source: L. 39: p. 550, § 3. CSA: C. 78, § 25(3). CRS 53: § 66-16-3. C.R.S. 1963: 

§ 66-16-3. L. 94: Entire section amended, p. 2742, § 381, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-1-404. Certificate presumptive evidence. By the authority of this part 4, every 
certificate of analysis of foods or drugs duly signed by the state chemist shall be 
presumptive evidence of the facts therein stated. 

Source: L. 39: p. 550, § 4. CSA: C. 78, § 25(4). CRS 53: § 66-16-4. C.R.S. 1963: 

§ 66-16-4. 

PART 5 
PUBLIC HEALTH 

Editor's note: This part 5 was numbered as article 2 of chapter 66, C.R.S. 1963. The substantive 
provisions of this part 5 were repealed and reenacted in 2008, resulting in the addition, relocation, and 
elimination of sections as well as subject matter. For amendments to this part 5 prior to 2008, consult 



25-1-501 Health Title 25 - page 40 

the Colorado statutory research explanatory note and the table itemizing the replacement volumes and 
supplements to the original volume of C.R.S. 1973 beginning on page vii in the front of this volume. 
Former C.R.S. section numbers are shown in editor's notes following those sections that were 
relocated. For a detailed comparison of this part 5, see the comparative tables located in the back of 
the index. 

Cross references: For right to establish disposal districts in counties maintaining health depart- 
ments, see part 2 of article 20 of title 30. 

Law reviews: For article, "Using Local Police Powers to Protect the Environment", see 24 Colo. 
Law. 1063 (1995). 

SUBPART 1 
GENERAL 

25-1-501. Legislative declaration. (1) The general assembly hereby finds and de- 
clares that: 

(a) The public health system reduces health care costs by preventing disease and injury, 
promoting healthy behavior, and reducing the incidents of chronic diseases and conditions. 
Thus, the public health system is a critical part of any health care reform. 

(b) Each community in Colorado should provide high-quality public health services 
regardless of its location. Thus, the state of Colorado and each local public health agency 
should have a comprehensive public health plan outlining how quality public health 
services will be provided. 

(c) Each county should establish or be part of a local public health agency organized 
under a local board of health with a public health director and other staff necessary to 
provide public health services; 

(d) A strong public health infrastructure is needed to provide essential public health 
services and is a shared responsibility among state and local public health agencies and their 
partners within the public health system; and 

(e) Developing a strong public health infrastructure requires the coordinated efforts of 
state and local public health agencies and their public and private sector partners within the 
public health system to: 

(I) Identify and provide leadership for the provision of essential public health services; 

(II) Develop and support an information infrastructure that supports essential public 
health services and functions; 

(III) Develop and provide effective education and training for members of the public 
health workforce; 

(IV) Develop performance- management standards for the public health system that are 
tied to improvements in public health outcomes or other measures; and 

(V) Develop a comprehensive plan and set priorities for providing essential public 
health services. 

Source: L. 2008: Entire part R&RE, p. 2030, § 1, effective July 1. 

25-1-502. Definitions. As used in this part 5, unless the context otherwise requires: 

(1) "Agency" means a county or district public health agency established pursuant to 
section 25-1-506. 

(2) "Core public health" shall be defined by the state board and shall include, but need 
not be limited to, the assessment of health status and health risks, development of policies 
to protect and promote health, and assurance of the provision of the essential public health 
services. 

(3) "Essential public health services" means to: 

(a) Monitor health status to identify and solve community health problems; 

(b) Investigate and diagnose health problems and health hazards in the community; 

(c) Inform, educate, and empower individuals about health issues; 



Title 25 - page 41 Administration 25-1-503 

(d) Mobilize public and private sector collaboration and action to identify and solve 
health problems; 

(e) Develop policies, plans, and programs that support individual and community 
health efforts; 

(f) Enforce laws and rules that protect health and promote safety; 

(g) Link individuals to needed personal health services and ensure the provision of 
health care; 

(h) Encourage a competent public health workforce; 

(i) Evaluate effectiveness, accessibility, and quality of personal and population-based 
public health services; and 

(j) Contribute to research into insightful and innovative solutions to health problems. 

(4) "Medical officer" means a volunteer or paid licensed physician who contracts with 
or is employed by a county or district public health agency to advise the public health 
director on medical decisions if the public health director is not a licensed physician. 

(5) "Public health" means the prevention of injury, disease, and premature mortality; 
the promotion of health in the community; and the response to public and environmental 
health needs and emergencies and is accomplished through the provision of essential public 
health services. 

(6) "Public health agency" means an organization operated by a federal, state, or local 
government or its designees that acts principally to protect or preserve the public's health. 
"Public health agency" includes a county public health agency or a district public health 
agency. 

(7) "Public health director" means the administrative and executive head of each 
county or district public health agency. 

(8) "Public health system" means state, county, and district public health agencies and 
other persons and organizations that provide public health services or promote public 
health. 

(9) "State board" means the state board of health created pursuant to section 25-1-103. 

(10) "State department" means the department of public health and environment 
created pursuant to section 25-1-102. 

Source: L. 2008: Entire part R&RE, p. 2031, § 1, effective July 1. 

25-1-503. State board - public health duties. (1) In addition to all other powers and 
duties conferred and imposed upon the state board, the state board has the following specific 
powers and duties: 

(a) To establish, by rule, the core public health services that each county and district 
public health agency must provide or arrange for the provision of said services; 

(b) To establish, by rule, the minimum quality standards for public health services; 

(c) To establish, by rule, the minimum qualifications for county and district public 
health directors and medical officers; 

(d) To ensure the development and implementation of a comprehensive, statewide 
public health improvement plan; 

(e) To review all county and district public health agency public health plans, which 
review shall be based on criteria established by rule by the state board and against which 
each county or district public health plan shall be evaluated; and 

(f) To establish, by rule, for the fiscal year beginning July 1, 2009, if practicable, and 
for each fiscal year thereafter, a formula for allocating moneys to county or district public 
health agencies based on input from the state department and from county or district public 
health agencies. 

Source: L. 2008: Entire part R&RE, p. 2032, § 1, effective July 1. 



25-1 -504 Health Title 25 - page 42 

SUBPART 2 
PUBLIC HEALTH PLANS 

25-1-504. Comprehensive public health plan - development - approval - reassess- 
ment - cash fund. (1) On or before December 31, 2009, and at a minimum on or before 
December 3 1 every five years thereafter, the state department shall develop a comprehen- 
sive, statewide public health improvement plan, referred to in this section as the "plan", 
that assesses and sets priorities for the public health system. The state board may appoint 
ad hoc or advisory committees as needed for the plan development process. The plan shall 
be developed in consultation with the state board and representatives from the state 
department, county or district public health agencies, and their partners within the public 
health system. The plan shall rely on existing or available data or other information acquired 
pursuant to this part 5, as well as national guidelines or recommendations concerning public 
health outcomes or improvements. 

(2) (a) The plan shall assess and set priorities for the public health system and shall: 

(I) Guide the public health system in targeting core public health services and functions 
through program development, implementation, and evaluation; 

(II) Increase the efficiency and effectiveness of the public health system; 

(III) Identify areas needing greater resource allocation to provide essential public health 
services; 

(IV) Incorporate, to the extent possible, goals and priorities of public health plans 
developed by county or district public health agencies; and 

(V) Consider available resources, including but not limited to state and local funding, 
and be subject to modification based on actual subsequent allocations. 

(b) The plan shall include or address at a minimum the following elements: 

(I) Core public health services and standards for county and district public health 
agencies; 

(II) Recommendations for legislative or regulatory action, including but not limited to 
updating public health laws, eliminating obsolete statutory language, and establishing an 
effective and comprehensive state and local public health infrastructure; 

(III) Identification and quantification of existing public health problems, disparities, or 
threats at the state and county levels; 

(IV) Identification of existing public health resources at the state and local levels; 

(V) Declaration of the goals of the plan; 

(VI) Identification of specific recommendations for meeting these goals; 

(VII) Development of public and environmental health infrastructure that supports core 
public health functions and essential public health services at the state and local levels; 

(VIII) Explanation of the prioritization of one or more conditions of public health 
importance; 

(IX) Detailed description of strategies to develop and promote culturally and linguis- 
tically appropriate services; 

(X) Development, evaluation, and maintenance of, and improvements to, an informa- 
tion infrastructure that supports essential public health services; 

(XI) Detailed description of the programs and activities that will be pursued to address 
existing public and environmental health problems, disparities, or threats; 

(XII) Detailed description of how public health services will be integrated and public 
health resources shared to optimize efficiency and effectiveness of the public health system; 

(XIII) Detailed description of how the plan will support county or district public health 
agencies in achieving the goals of their county or district public health plans; 

(XIV) Estimation of costs of implementing the plan; 

(XV) A timeline for implementing various elements of the plan; 

(XVI) A strategy for coordinating service delivery within the public health system; and 

(XVII) Measurable indicators of effectiveness and successes. 

(c) The plan, including core public health services and standards, shall prospectively 
cover up to five years, subject to annual revisions and the implementation schedule 
established by the state board. 



Title 25 - page 43 Administration 25-1-506 

(3) The state department shall make the plan available to the governor, the general 
assembly, the state board, county and district public health agencies, and other partners. 

(4) The state department is authorized to solicit and accept any gifts, grants, or 
donations to pay for the development of the plan. Any moneys received pursuant to this 
subsection (4) shall be transmitted to the state treasurer, who shall credit the same to the 
comprehensive public health plan cash fund, which is hereby created and referred to in this 
subsection (4) as the "fund". Any interest derived from the deposit and investment of 
moneys in the fund shall be credited to the fund. Any unexpended and unencumbered 
moneys remaining in the fund at the end of any fiscal year shall remain in the fund and shall 
not be credited or transferred to the general fund or another fund. Moneys in the fund may 
be expended by the state department, subject to annual appropriation by the general 
assembly, for the development of the plan described in this section. 

(5) If the moneys received by the state department through gifts, grants, and donations 
are insufficient to cover the direct and indirect costs of complying with the provisions of 
section 25-1-503 and this section, the state department shall not be required to implement 
the provisions of said sections. 

Source: L. 2008: Entire part R&RE, p. 2033, § 1, effective July 1. 

25-1-505. County and district public health plans - approval. (1) As soon as 
practicable after the approval of each comprehensive, statewide public health improvement 
plan pursuant to section 25-1-504, each county or district public health agency shall prepare 
a county or district public health plan, referred to in this section as the "local plan". Each 
local plan shall not be inconsistent with the comprehensive, statewide public health 
improvement plan required under section 25-1-504. 

(2) Each local plan shall, at a minimum: 

(a) Examine data about health status and risk factors in the local community; 

(b) Assess the capacity and performance of the county or district public health system; 

(c) Identify goals and strategies for improving the health of the local community; 

(d) Describe how representatives of the local community develop and implement the 
local plan; 

(e) Address how county or district public health agencies coordinate with the state 
department and others within the public health system to accomplish goals and priorities 
identified in the comprehensive, statewide public health improvement plan; and 

(f) Identify financial resources available to meet identified public health needs and to 
meet requirements for the provision of core public health services. 

(3) Subject to available appropriations, the state department shall encourage and 
provide technical assistance to county or district public health agencies that request such 
assistance and otherwise work with county or district public health agencies to generate 
their local plans. 

Source: L. 2008: Entire part R&RE, p. 2035, § 1, effective July 1. 

SUBPART 3 
COUNTY OR DISTRICT PUBLIC HEALTH AGENCIES 

25-1-506. County or district public health agency. (1) Each county, by resolution 
of its board of county commissioners, shall establish and maintain a county public health 
agency or shall participate in a district public health agency. Any two or more contiguous 
counties, by resolutions of the boards of county commissioners of the respective counties, 
may establish and maintain a district public health agency. An agency shall consist of a 
county or district board of health, a public health director, and all other personnel employed 
or retained under the provisions of this subpart 3. 

(2) (a) (I) The jurisdiction of any agency shall extend over all unincorporated areas 
and over all municipal corporations within the territorial limits of the county or the counties 
comprising the district, but not over the territory of any municipal corporation that 



25- 1 -506 Health Title 25 - page 44 

maintains its own public health agency. If the county has a county public health agency or 
a district board of health and if the county is within a district public health agency, any 
municipal corporation not otherwise within the jurisdiction of an agency, by agreement of 
its city council, board of trustees or other governing body, and the board of county 
commissioners of the county wherein the municipal corporation is situated may merge its 
department with the county or district public health agency. 

(II) In the event of a merger between a health department of a municipal corporation 
with a county or district public health agency, the agreement of merger, among other things, 
shall provide that a member or members of the county or district board of health, as is 
specified in the agreement, shall be appointed by the city council or board of trustees of the 
municipal corporation rather than as provided in this section. The city council or board of 
trustees shall appoint the number of members specified in the agreement of merger, and the 
remaining members shall be appointed as provided in this section. 

(III) The board of county commissioners, in order to give the municipal corporation 
representation on a county board of health previously established, may declare vacancies in 
the county board of health and permit the vacancies to be filled by the city council or board 
of trustees of the municipal corporation. 

(b) All county or district boards of health existing within the county or district shall be 
dissolved upon the organization of a county or district public health agency under the 
provisions of this part 5 or upon the acceptance of a county into a district already 
established. 

(c) In the event of the dissolution of any county or district public health agency, the 
withdrawal of a county from an established district, or the withdrawal of a municipal 
corporation that has voluntarily merged its health department or agency with a county or 
district public health agency, local boards of health shall be reestablished under the 
provisions of this part 5 and assume the powers and duties conferred upon such local 
boards. 

(3) (a) Subject to available appropriations, an agency shall provide or arrange for the 
provisions of services necessary to carry out the public health laws and rules of the state 
board, the water quality control commission, the air quality control commission, and the 
solid and hazardous waste commission according to the specific needs and resources 
available within the community as determined by the county or district board of health or 
the board of county commissioners and as set out in both the comprehensive, statewide 
public health improvement plan developed pursuant to section 25-1-504 and the county or 
district public health plan developed pursuant to section 25-1-505. 

(b) In addition to other powers and duties, an agency shall have the following duties: 

(I) To complete a community health assessment and to create the county or district 
public health plan at least every five years under the direction of the county or district board 
and to submit the plan to the county or district board and state board for review; 

(II) To advise the county or district board on public policy issues necessary to protect 
public health and the environment; 

(III) To provide or arrange for the provision of quality, core public health services 
deemed essential by the state board and the comprehensive, statewide public health 
improvement plan; except that the agency shall be deemed to have met this requirement if 
the agency can demonstrate to the county or district board that other providers offer core 
public health services that are sufficient to meet the local needs as determined by the plan; 

(IV) To the extent authorized by the provisions of this title or article 20 of title 30, 
C.R.S., to administer and enforce the laws pertaining to: 

(A) Public health, air pollution, solid and hazardous waste, and water quality; 

(B) Vital statistics; and 

(C) The orders, rules, and standards of the state board and any other type 1 agency 
created pursuant to the provisions of this title; 

(V) To investigate and control the causes of epidemic or communicable diseases and 
conditions affecting public health; 

(VI) To establish, maintain, and enforce isolation and quarantine, and in pursuance 
thereof, and for this purpose only, to exercise physical control over property and over the 



Title 25 - page 45 



Administration 



25-1-507 



persons of the people within the jurisdiction of the agency as the agency may find necessary 
for the protection of the public health; 

(VII) To close schools and public places and to prohibit gatherings of people when 
necessary to protect public health; 

(VIII) To investigate and abate nuisances when necessary in order to eliminate sources 
of epidemic or communicable diseases and conditions affecting public health; 

(IX) To establish, maintain, or make available chemical, bacteriological, and biological 
laboratories, and to conduct such laboratory investigations and examinations as it may deem 
necessary or proper for the protection of the public health; 

(X) To purchase and distribute to licensed physicians and veterinarians, with or without 
charge, as the county or district board may determine upon considerations of emergency or 
need, approved biological or therapeutic products necessary for the protection of public 
health; 

(XI) To initiate and carry out health programs consistent with state law that are 
necessary or desirable by the county or district board to protect public health and the 
environment; 

(XII) To collect, compile, and tabulate reports of marriages, dissolutions of marriage, 
and declarations of invalidity of marriage, births, deaths, and morbidity, and to require any 
person having information with regard to the same to make such reports and submit such 
information as is required by law or the rules of the state board; 

(XIII) To make necessary sanitation and health investigations and inspections, on its 
own initiative or in cooperation with the state department, for matters affecting public health 
that are within the jurisdiction and control of the agency; and 

(XIV) To collaborate with the state department and the state board in all matters 
pertaining to public health, the water quality control commission in all matters pertaining 
to water quality, the air quality control commission and the division of administration of the 
state department in all matters pertaining to air pollution, and the solid and hazardous waste 
commission in all matters pertaining to solid and hazardous waste. 

(c) If a county or district board of health does not receive sufficient appropriations to 
fulfill all the duties described in paragraph (b) of this subsection (3), the county or district 
board shall set priorities for fulfilling the duties and shall include the list of priorities in its 
county or district public health plan submitted pursuant to section 25-1-505. 

(4) Repealed. 

Source: L. 2008: Entire part R&RE, p. 2036, § 1, effective July 1. 

Editor's note: (1) The provisions of this section are similar to provisions of several former 
sections as they existed prior to 2008. For a detailed comparison, see the comparative tables located 
in the back of the index. 

(2) Subsection (4)(b) provided for the repeal of subsection (4), effective July 1, 2009. (See L. 
2008, p. 2036.) 

ANNOTATION 



Law reviews. For article, "Synthetic Fuels — 
Policy and Regulation", see 51 U. Colo. L. Rev. 
465 (1980). 

Annotator's note. Since § 25-1-506 is sim- 
ilar to §§ 25-1-501 and 25-1-506 as they existed 
prior to the 2008 repeal and reenactment of this 
part 5, relevant cases construing those provi- 
sions have been included in the annotations to 
this section. 

Overview of the state's three-tiered public 
health system and the responsibilities delegated 



under parts 5 and 6 of this article appears in 
Jefferson County Health Servs. Ass'n v. Feeney, 
974 R2d 1001 (Colo. 1998). 

County board of health, not the board of 
county commissioners, is the "governing body" 
of a county health department for purposes of 
notice under the Colorado Governmental Immu- 
nity Act. Jefferson County Health Servs. Ass'n 
V. Feeney, 974 R2d 1001 (Colo. 1998). 

Applied in Johnson v. Jefferson County Bd. 
of Health, 662 R2d 463 (Colo. 1983). 



25-1-507. Municipal board of health. Except as otherwise provided by law, the mayor 
and council of each incorporated town or city, whether incorporated under general statutes 



25-1-508 Health Title 25 - page 46 

or special charter in this state, may establish a municipal public health agency and appoint 
a municipal board of health. If appointed, the municipal board of health shall have all the 
powers and responsibilities and perform all the duties of a county or district board of health 
as provided in this part 5 within the limits of the respective city or town of which they are 
the officers. 

Source: L. 2008: Entire part R&RE, p. 2039, § 1, effective July 1. 

Editor's note: This section is similar to former § 25-1-609 as it existed prior to 2008. 

25-1-508. County or district boards of public health - public health directors. 

(1) Within ninety days after the adoption of a resolution to establish and maintain a county 
public health agency or to participate in a district public health agency, the respective board 
of county commissioners shall proceed to organize the agency by the appointment of a 
county or district board of health, referred to in this part 5 as a "county or district board". 

(2) (a) (I) Each county board of health shall consist of at least five members to be 
appointed by the board of county commissioners for five-year terms; except that the board 
of county commissioners shall stagger the terms of the initial appointments. Thereafter, 
full-term appointments shall be for five years. 

(II) Notwithstanding the provisions of subparagraph (I) of this paragraph (a), a county 
with a population of less than one hundred thousand people may have a county board of 
health that consists of at least three members to be appointed by the board of county 
commissioners for five-year terms; except that the board of county commissioners shall 
stagger the terms of the initial appointments. Thereafter, full-term appointments shall be for 
five years. 

(b) Each member of the county board of health shall be a resident of the county in 
which the county agency is located. Appointments shall be made to the board so that no 
business or professional group or governmental entity shall constitute a majority of the 
board. Any vacancy on the board shall be filled in the same manner as full-term appoint- 
ments by the appointment of a qualified person for the unexpired term. 

(c) In a county with a population of less than one hundred thousand people that, as of 
July 1, 2008, does not have a board of health that is separate from the board of county 
commissioners, the board of county commissioners may designate itself as the county board 
of health as of July 1, 2008. The terms of the members of the county board of health shall 
coincide with their terms as commissioners. Such county boards shall assume all the duties 
of appointed county boards. 

(d) Notwithstanding the provisions of paragraphs (a) to (c) of this subsection (2), a 
county board of health in a home-rule county shall comply with the requirements of its 
home-rule charter. 

(3) (a) Each district board of health shall consist of a minimum of five members. The 
membership of each district board of health shall include at least one representative from 
each county in the district. The members of the board shall be appointed by an appointments 
committee composed of one member of each of the boards of county commissioners of the 
counties comprising the district. The appointments committee for each district board shall 
designate the number of members of its district board and shall establish staggered terms for 
the initial appointments. Thereafter, full-term appointments shall be for five years. 

(b) Each member of the district board shall be a resident of one of the counties 
comprising the district, and there shall be at least one member from each of the counties 
comprising the district. Appointments shall be made to the district board so that no business 
or professional group or governmental entity shall constitute a majority of the district board. 
The appointments committee shall fill any vacancy on the district board by the appointment 
of a qualified person for the remainder of the unexpired term. 

(c) Upon establishment of a district board, all county boards previously existing within 
the county or district shall be dissolved. Upon the acceptance of a new county into an 
established district, the county or district board previously existing for the county being 
added shall be dissolved and the chair of the previous county or district board or the chair's 



Title 25 - page 47 Administration 25-1-508 

designee shall represent the new county on the district board until a new member is 
appointed by the appointments committee. 

(4) (a) A county or district board, at its organizational meeting, shall elect from its 
members a president and other officers as it shall determine. The public health director of 
the agency, at the discretion of the board, may serve as secretary but shall not be a member 
of the board. All officers and the public health director shall hold their positions at the 
pleasure of the board. 

(b) (I) Regular meetings of a county or district board shall be held at least once every 
three months at such times as may be established by resolution of the board. Special 
meetings of a board may be called by the president, by the public health director, or by a 
majority of the members of the board at any time on three days' prior notice; except that, 
in case of emergency, twenty-four hours' notice shall be sufficient. 

(II) A county or district board may adopt, and at any time may amend, bylaws in 
relation to its meetings and the transaction of its business. A majority of the board shall 
constitute a quorum. Members of the board shall serve without compensation but shall be 
reimbursed for their actual and necessary travel and subsistence expenses to attend 
meetings. 

(5) In addition to all other powers and duties conferred and imposed upon a county 
board of health or a district board of health by the provisions of this subpart 3, a county 
board of health or a district board of health shall have and exercise the following specific 
powers and duties: 

(a) To develop and promote the public policies needed to secure the conditions 
necessary for a healthy community; 

(b) To approve the local public health plan completed by the county or district agency, 
and to submit the local plan to the state board for review; 

(c) (I) To select a public health director to serve at the pleasure of the county or district 
board. The public health director shall possess such minimum qualifications as may be 
prescribed by the state board. A public health director may be a physician, a public health 
nurse, or other qualified public health professional. A public health director may practice 
medicine or nursing within his or her license and scope of practice, as necessary, to carry 
out the functions of the office of the public health director. The qualifications shall reflect 
the resources and needs of the county or counties covered by the agency. If the public health 
director is not a physician, the county or district board shall employ or contract with at least 
one medical officer to advise the public health director on medical decisions. The public 
health director shall maintain an office location designated by the county or district board 
and shall be the custodian of all property and records of the agency. 

(II) A person employed or under contract to act as a medical officer pursuant to this 
paragraph (c) shall be covered by the "Colorado Governmental Immunity Act", article 10 
of title 24, C.R.S., for duties performed for the agency. 

(d) (I) In the event of a vacancy in the position of public health director or medical 
officer, to either employ or contract with a person deemed qualified to fill the position or to 
request temporary assistance from a public health director or a medical officer from another 
county. The county or district board may also request that an employee of the state 
department, such as a qualified executive director or the chief medical officer, serve on an 
interim basis with all the powers and duties of the position. 

(II) A person filling a temporary vacancy as public health director or medical officer 
shall be covered by the "Colorado Governmental Immunity Act", article 10 of title 24, 
C.R.S., for duties performed for the agency. 

(e) To provide, equip, and maintain suitable offices and all necessary facilities for the 
proper administration and provision of core public health services, as defined by the state 
board; 

(f) To determine general policies to be followed by the public health director in 
administering and enforcing public health laws, orders, and rules of the county or district 
board, and orders, rules, and standards of the state board; 

(g) To issue orders and to adopt rules not inconsistent with the public health laws of this 
state nor with the orders or rules of the state board as the county or district board may deem 



25-1-508 



Health 



Title 25 - page 48 



necessary for the proper exercise of the powers and duties vested in or imposed upon an 
agency or county or district board by this part 5; 

(h) To act in an advisory capacity to the public health director on all matters pertaining 
to public health; 

(i) To hold hearings, administer oaths, subpoena witnesses, and take testimony in all 
matters relating to the exercise and performance of the powers and duties vested in or 
imposed upon a county or district board; 

(j) To provide environmental health services and to assess fees to offset the actual, 
direct cost of such services; except that no fee for a service shall be assessed against any 
person who has already paid a fee to the state or federal government for the service, and 
except that the only fee that shall be charged for annual retail food establishment 
inspections shall be the fee set forth in section 25-4-1607; 

(k) To accept and, through the public health director, to use, disburse, and administer 
all federal aid, state aid, or other property, services, or moneys allotted to an agency for 
county or district public health functions or allotted without designation of a specific agency 
for purposes that are within the functions of an agency, and to prescribe, by rule consistent 
with the laws of this state, the conditions under which the property, services, or moneys 
shall be accepted and administered. The county or district board is empowered to make 
agreements that may be required to receive such moneys or other assistance. 

(1) To approve, as provided for in section 25-1-520, a clean syringe exchange program 
proposed by an agency. A county board of health or district board of health shall not be 
required to approve a proposed program. 

(6) Repealed. 

Source: L. 2008: Entire part R&RE, p. 2039, § 1, effective July 1. L. 2010: IP(5) and 

(5)(j) amended and (5)(1) added, (SB 10-189), ch. 272, p. 1252, § 2, effective August 11. 

Editor's note: (1) The provisions of this section are similar to provisions of several former 
sections as they existed prior to 2008. For a detailed comparison, see the comparative tables located 
in the back of the index. 

(2) Subsection (6)(b) provided for the repeal of subsection (6), effective July 1, 2009. (See L. 
2008, p. 2039.) 

ANNOTATION 



Law reviews. For article, "A Review of the 
1959 Constitutional and Administrative Law 
Decisions", see 37 Dicta 81 (1960). 

Annotator's note. Since § 25-1-508 is sim- 
ilar to §§ 25-1-505, 25-1-507, 25-1-601, and 
25-1-610 as they existed prior to the 2008 repeal 
and reenactment of this part 5, relevant cases 
construing those provisions have been included 
in the annotations to this section. 

This section is unlawful delegation of leg- 
islative power. Subsection (l)(d), delegating 
power to local boards of health to adopt rules 
and regulations, and § 25-1-514 (l)(a), provid- 
ing that a violation of such rules and regulations 
shall be a misdemeanor, constitute an unlawful 
delegation of power to the executive department 
to define a crime in violation of Colo. Const, art. 
III. Casey v. People, 139 Colo. 89, 336 R2d 308 
(1959). 

The general assembly cannot lawfully dele- 
gate its power of defining a crime to district or 
county health departments. Casey v. People, 139 
Colo. 89, 336 P2d 308 (1959). 

County board's rules may not override 
statutory authority. County personnel rules. 



even though adopted by the county board of 
health, do not override the explicit statutory 
authority of the board to discharge a public 
health officer appointed by the board at any time 
without cause or formal procedure. Johnson v. 
Jefferson County Bd. of Health, 662 P2d 463 
(Colo. 1983). 

A county board of health, as a political sub- 
division of the state, may not by rule or regula- 
tion abdicate the authority and responsibility 
delegated to it by the general assembly. Johnson 
V. Jefferson County Bd. of Health, 662 P2d 463 
(Colo. 1983). 

Overview of the state's three-tiered public 
health system and the responsibilities delegated 
under parts 5 and 6 of this article appears in 
Jefferson County Health Svcs. Ass'n v. Feeney, 
974 P2d 1001 (Colo. 1998). 

County board of health, not the board of 
county commissioners, is the "governing body" 
of a county health department for purposes of 
notice under the Colorado Governmental Immu- 
nity Act. Jefferson County Health Svcs. Ass'n v. 
Feeney, 974 P2d 1001 (Colo. 1998). 



Title 25 - page 49 



Administration 



25-1-509 



Board may not discharge employee in re- 
taliation for exercise of free speech rights. 

Even though a public health officer is subject to 
discharge at the pleasure of the board, this does 
not mean that the board's discretion is limitless. 
It is well established that even where a govern- 
ment employer may discharge an employee for 
no reason whatsoever, it nevertheless may not 
discharge that employee in retaliation for the 
exercise of his free speech rights. Johnson v. 
Jefferson County Bd. of Health, 662 P.2d 463 
(Colo. 1983). 

Resignation prompted by threat of dismis- 
sal is equivalent of refusal to rehire. A resig- 



nation precipitated by the threat of dismissal is 
the substantive equivalent of a refusal to rehire 
by the board. Johnson v. Jefferson County Bd. of 
Health, 662 P.2d 463 (Colo. 1983). 

Appointed physician may substitute an- 
other physician's services. Even if the contract 
between a county and a physician to provide 
medical attention for the poor were one which 
called for personal services, it would be unrea- 
sonable to hold that the physician could not 
substitute another reputable physician in his 
stead during sickness or temporary absence. Bd. 
of County Comm'rs v. Bedell, 13 Colo. App. 
261, 57 P. 187 (1899). 



25-1-509. County and district public health directors. (1) (a) The director of each 
agency shall be the public health director. 

(b) All other personnel required by an agency shall be selected by the public health 
director. All personnel shall perform duties as prescribed by the public health director. 

(c) In the event of a public health emergency, the agency shall issue orders and adopt 
rules consistent with the laws and rules of the state as the public health director may deem 
necessary for the proper exercise of the powers and duties vested in or imposed upon the 
agency or county or district board. 

(2) In addition to the other powers and duties conferred by this part 5 or by the agency, 
a public health director has the following powers and duties: 

(a) To administer and enforce: 

(I) The public health laws of the state and, as authorized by the provisions of this title 
or article 20 of title 30, C.R.S., the public health orders, rules, and standards of the state 
department or the state board; and 

(II) The orders and rules of the county or district board; 

(b) To exercise all powers and duties conferred and imposed upon agencies not 
expressly delegated by the provisions of this part 5 to a county or district board; 

(c) To hold hearings, administer oaths, subpoena witnesses, and take testimony in all 
matters relating to the exercise and performance of his or her powers and duties; 

(d) To act as the local registrar of vital statistics or to contract out the responsibility of 
registrar in the area over which the agency has jurisdiction; 

(e) To direct the resources needed to carry out the county or district public health plan 
developed pursuant to section 25-1-505; and 

(f) If requested by the county or district board, to serve as secretary to the board 
responsible for maintaining all records required by part 2 of article 72 of title 24, C.R.S., 
and ensuring public notice of all meetings in accordance with part 4 of article 6 of title 24, 
C.R.S. The director shall be the custodian of all properties and records for the agency. 

Source: L. 2008: Entire part R&RE, p. 2043, § 1, effective July 1. 

Editor's note: This section is similar to former §§ 25-1-505 (3) and 25-1-508 as they existed prior 
to 2008. 

ANNOTATION 



Annotator's note. Since § 25-1-509 is sim- 
ilar to §§ 25-1-505 and 25-1-508 as they existed 
prior to the 2008 repeal and reenactment of this 
part 5, a relevant case construing those provi- 
sions has been included in the annotations to this 
section. 

County personnel rules do not override 
statutory authority. County personnel rules, 
even though adopted by the county board of 



health, do not override the explicit statutory 
authority of the board to discharge a public 
health officer appointed by the board at any time 
without cause or formal procedure. Johnson v. 
Jefferson County Bd. of Health, 662 P2d 463 
(Colo. 1983). 

A county board of health, as a political sub- 
division of the state, may not by rule or regula- 
tion abdicate the authority and responsibility 



25-1-510 



Health 



Title 25 - page 50 



delegated to it by the general assembly. Johnson 
V. Jefferson County Bd. of Health, 662 P.2d 463 
(Colo. 1983). 

Board may not discharge employee in re- 
taliation for exercise of free speech rights. 
Even though a public health officer is subject to 
discharge at the pleasure of the board, this does 
not mean that the board's discretion is limitless. 
It is well established that even where a govern- 
ment employer may discharge an employee for 
no reason whatsoever, it nevertheless may not 
discharge that employee in retaliation for the 
exercise of his free speech rights. Johnson v. 
Jefferson County Bd. of Health, 662 P.2d 463 
(Colo. 1983). 



Even with the enhanced potential for negative 
impact which the public statements of a policy- 
making employee may bear on the efficiency of 
governmental functions, the policymaking em- 
ployee may nonetheless demonstrate that the 
interest in allowing free commentary on a matter 
of public concern overrides any governmental 
interest. Johnson v. Jefferson County Bd. of 
Health, 662 P.2d 463 (Colo. 1983). 

Resignation prompted by threat of dismis- 
sal is equivalent of refusal to rehire. A resig- 
nation precipitated by the threat of dismissal is 
the substantive equivalent of a refusal to rehire 
by the board. Johnson v. Jefferson County Bd. of 
Health, 662 P.2d 463 (Colo. 1983). 



25-1-510. County or district board unable or unwilling to act. (1) If the county or 
district board is unable or unwilling to efficiently or promptly abate a nuisance or prevent 
the introduction or spread of a contagious or infectious disease, the county or district board 
or agency shall notify the state department and request assistance to take measures that will 
abate the nuisance or prevent the introduction or spread of disease. 

(2) Upon receipt of the notice and request described in subsection ( 1 ) of this section, 
or upon determination that the county or district board is unable or unwilling to act, the state 
department has full power to take measures to ensure the abatement of the nuisance or 
prevent the introduction or spread of disease. The state department, for this purpose, may 
assume all powers conferred by law on the county or district board. 

(3) The state department may reallocate state moneys from an agency that is not able 
to provide core public health services or standards to another entity to deliver services in 
that agency's jurisdiction. 

Source: L. 2008: Entire part R&RE, p. 2044, § 1, effective July 1. 

Editor's note: This section is similar to former § 25-1-602 as it existed prior to 2008. 



25-1-511. County treasurer - agency funds. ( 1 ) In the case of a county public health 
agency, the county treasurer, as a part of his or her official duties as county treasurer, shall 
serve as treasurer of the agency, and the treasurer's official bond as county treasurer shall 
extend to and cover his or her duties as treasurer of the agency. In the case of a district 
public health agency, the county treasurer of the county in the district having the largest 
population as determined by the most recent federal census, as a part of his or her official 
duties as county treasurer, shall serve as treasurer of the district agency, and the treasurer's 
official bond as county treasurer shall extend to and cover his or her duties as treasurer of 
the district agency. 

(2) The treasurer of an agency, upon organization of the agency, shall create a county 
or district public health agency fund, to which shall be credited: 

(a) Any moneys appropriated from a county general fund; and 

(b) Any moneys received from state or federal appropriations or any other gifts, grants, 
donations, or fees for local public health purposes. 

(3) Any moneys credited to a fund created pursuant to subsection (2) of this section 
shall be expended only for the purposes of this part 5, and claims or demands against the 
fund shall be allowed only if certified by the public health director and the president of the 
county or district board or any other member of the county or district board designated by 
the president for such purpose. 

(4) On or before September 1, 2008, and on or before September 1 of each year 
thereafter, a county board of health shall estimate the total cost of maintaining the county 
public health agency for the ensuing fiscal year, and the amount of moneys that may be 
available from unexpended surpluses or from state or federal funds or other grants or 
donations. On or before September 1 of each year, the estimates shall be submitted in the 



Title 25 -page 51 



Administration 



25-1-512 



form of a budget to the board of county commissioners. The board of county commissioners 
is authorized to provide any moneys necessary, over estimated moneys from surpluses, 
grants, and donations, to cover the total cost of maintaining the agency for the ensuing fiscal 
year by an appropriation from the county general fund. 

(5) On or before September 1, 2008, and on or before September 1 of each year 
thereafter, a district board of health shall estimate the total cost of maintaining the district 
public health agency for the ensuing fiscal year, and the amount of moneys that may be 
available from unexpended surpluses or from state or federal funds or other grants or 
donations. On or before September 1 of each year, the estimates shall be submitted in the 
form of a budget to a committee composed of the chairs of the boards of county 
commissioners of all counties comprising the district. The cost for maintaining the agency, 
over estimated moneys from surpluses, grants, or donations, shall be apportioned by the 
committee among the counties comprising the district in the proportion that the population 
of each county in the district bears to the total population of all counties in the district, 
population figures to be based on the most recent federal census. The boards of county 
commissioners of the respective counties are authorized to provide any moneys necessary 
to cover the proportionate shares of their counties by an appropriation from the county 
general fund. 

Source: L. 2008: Entire part R&RE, p. 2044, § 1, effective July 1. 

Editor's note: This secfion is similar to former §§ 25-1-505 (2) and 25-1-509 as they existed prior 
to 2008. 

ANNOTATION 



Annotator's note. Since § 25-1-511 is sim- 
ilar to §§ 25-1-505 as it existed prior to the 
2008 repeal and reenactment of this part 5, a 
relevant case construing that provision has been 
included in the annotations to this section. 

County personnel rules do not override 
statutory authority. County personnel rules, 
even though adopted by the county board of 
health, do not override the explicit statutory 
authority of the board to discharge a public 
health officer appointed by the board at any time 
without cause or formal procedure. Johnson v. 
Jefferson County Bd. of Health, 662 P.2d 463 
(Colo. 1983). 

A county board of health, as a polifical sub- 
division of the state, may not by rule or regula- 
fion abdicate the authority and responsibility 
delegated to it by the general assembly. Johnson 
V Jefferson County Bd. of Health, 662 P.2d 463 
(Colo. 1983). 



Board may not discharge employee in re- 
taliation for exercise of free speech rights. 

Even though a public health officer is subject to 
discharge at the pleasure of the board, this does 
not mean that the board's discretion is limitless. 
It is well established that even where a govern- 
ment employer may discharge an employee for 
no reason whatsoever, it nevertheless may not 
discharge that employee in retaliation for the 
exercise of his free speech rights. Johnson v. 
Jefferson County Bd. of Health, 662 P.2d 463 
(Colo. 1983). 

Resignation prompted by threat of dismis- 
sal is equivalent of refusal to rehire. A resig- 
nation precipitated by the threat of dismissal is 
the substantive equivalent of a refusal to rehire 
by the board. Johnson v. Jefferson County Bd. of 
Health, 662 P.2d 463 (Colo. 1983). 



25-1-512. Allocation of moneys - public health services support fund - created. 

(1) (a) The state department shall allocate any moneys that the general assembly may 
appropriate for distribution to county or district public health agencies organized pursuant 
to this part 5 for the provision of local health services. The state board shall determine the 
basis for the allocation of moneys to the agencies. In determining the allocation of moneys, 
the state board shall take into account the population served by each agency, the additional 
costs involved in operating small or rural agencies, and the scope of services provided by 
each agency. 

(b) (I) In order to qualify for state assistance, each county and city and county shall 
contribute a minimum of one dollar and fifty cents per capita for its local health services and 
may contribute additional amounts as it may determine to be necessary to meet its local 
health needs. 



25- 1 -5 1 3 Health Title 25 - page 52 

(II) Notwithstanding the provisions of subparagraph (I) of this paragraph (b), for a 
district public health agency, the counties or cities and counties of the district in total shall 
contribute a minimum of one dollar and fifty cents per capita for local health services within 
the district. 

(c) Federally funded and state-funded special projects and demonstrations shall be in 
addition to the allotments specified in paragraph (b) of this subsection (1). 

(2) The public health services support fund is hereby created in the state treasury and 
shall be known in this section as the "fund". The principal of the fund shall consist of 
tobacco litigation settlement moneys transferred by the state treasurer to the fund pursuant 
to section 24-75-1104.5 (1.5) (a) (IV), C.R.S., and shall, subject to annual appropriation by 
the general assembly to the state department, be allocated by the state department to all 
agencies authorized pursuant to this part 5 as specified in subsection (1) of this section; 
except that, at the end of the 201 1-12 fiscal year and at the end of each fiscal year thereafter, 
all unexpended and unencumbered principal of the fund shall be transferred to the general 
fund, in accordance with section 24-75-1104.5 (1.5) (b), C.R.S. Interest and income earned 
on the deposit and investment of moneys in the public health services support fund before 
July 1, 2011, shall be credited to the fund and shall remain in the fund until the end of the 
fiscal year in which credited, when it shall be transferred to the general fund. 

Source: L. 2008: Entire part R&RE, p. 2045, § 1, effective July 1. L. 2009: (2) 
amended, (SB 09-292), ch. 369, p. 1969, § 82, effective August 5. L. 2011: (2) amended, 
(SB 11-225), ch. 189, p. 730, § 3, effective May 19. L. 2012: (2) amended, (HB 12-1247), 
ch. 53, p. 193, § 3, effective March 22. 

Editor's note: This section is similar to former § 25-1-516 as it existed prior to 2008. 

25-1-513. Enlargement of or withdrawal from public health agency. (1) Any 

county contiguous to a district maintaining a district public health agency may become a 
part of the district by agreement between its board of county commissioners and the boards 
of county commissioners of the counties comprising the district. The county, upon being 
accepted into the district, shall thereupon become subject to the provisions of this part 5. 

(2) Any county in a district maintaining a district public health agency may withdraw 
from the district by resolution of its board of county commissioners. A county may not 
withdraw from a district within the two-year period following the establishment of the 
district or the county becoming a part of the district. A county may only withdraw from a 
district after one year' s written notice given to the agency. In the event of withdrawal of a 
county from a district, any moneys that had been appropriated by the county before 
withdrawal to cover its proportionate share of maintaining the district may be returned to 
the county. A county shall establish a county public health agency or join another district 
public health agency once the county withdraws from a district. 

(3) A municipal corporation that has voluntarily merged its public health agency with 
a county or district public health agency under the authority of section 25-1-506 may 
withdraw from the county or district public health agency by resolution of its city council, 
board of trustees, or other governing body. A municipal corporation may not withdraw from 
an agency within the two-year period following the municipal corporation becoming a part 
of the agency. A county may only withdraw from a district ninety days after a written notice 
is given to the agency. 

Source: L. 2008: Entire part R&RE, p. 2046, § 1, effective July 1. 

Editor's note: This section is similar to former § 25-1-511 as it existed prior to 2008. 

25-1-514. Legal actions - legal adviser. The county attorney for the county or the 
district attorney of the judicial district in which a cause of action arises shall bring any civil 
or criminal action requested by a county or district public health director to abate a 
condition that exists in violation of, or to restrain or enjoin any action that is in violation 



Title 25 - page 53 Administration 25- 1 -5 1 6 

of, or to prosecute for the violation of or for the enforcement of, the public health laws and 
the standards, orders, and rules of the state board or a county or district board of health. If 
the county attorney or the district attorney fails to act, the public health director may bring 
an action and be represented by special counsel employed by him or her with the approval 
of the county or district board. An agency, through its county or district board of health or 
through its public health director with the approval of the state board, may employ or retain 
and compensate an attorney to be the legal adviser of the agency and to defend all actions 
and proceedings brought against the agency or the officers and employees of the agency. 

Source: L. 2008: Entire part R&RE, p. 2047, § 1, effective July 1. 

Editor's note: This section is similar to former § 25-1-512 as it existed prior to 2008. 

25-1-515. Judicial review of decisions. (1) Any person aggrieved and affected by a 
decision of a county or district board of health or a public health director acting under the 
provisions of this part 5 shall be entitled to judicial review by filing, in the district court of 
any county over which the county or district board or public health director has jurisdiction, 
an appropriate action requesting the review within ninety days after the public announce- 
ment of the decision. The court may make any interested person a party to the action. The 
review shall be conducted by the court without a jury and shall be confined to the record, 
if a complete record is presented. In a case of alleged irregularities in the record or in the 
procedure before the county or district board or public health director, testimony may be 
taken in the court. The court may affirm the decision or may reverse or modify it if the 
substantial rights of the appellant have been prejudiced as a result of the findings and 
decision of the county or district board being: 

(a) Contrary to constitutional rights or privileges; 

(b) In excess of the statutory authority or jurisdiction of the county or district board or 
public health director; 

(c) Affected by any error of law; 

(d) Made or promulgated upon unlawful procedure; 

(e) Unsupported by substantial evidence in view of the entire record as submitted; or 

(f) Arbitrary or capricious. 

(2) Any party may have a review of the final judgment or decision of the district court 
by appellate review in accordance with law and the Colorado appellate rules. 

Source: L. 2008: Entire part R&RE, p. 2047, § 1, effective July 1. 

Editor's note: This section is similar to former § 25-1-513 as it existed prior to 2008. 

ANNOTATION 

Applied in C Bar H, Inc. v. Bd. of Health ex 
rel. Jefferson County, 56 P.3d 1189 (Colo. App. 
2002) (decided under former § 25-1-513). 

25-1-516. Unlawful acts - penalties. (1) It is unlawful for any person, association, or 
corporation and the officers thereof to: 

(a) Willfully violate, disobey, or disregard the provisions of the public health laws or 
the terms of any lawful notice, order, standard, or rule; 

(b) Fail to make or file a report required by law or rule of the state board relating to the 
existence of disease or other facts and statistics relating to the public health; 

(c) Willfully and falsely make or alter a certificate or certified copy of any certificate 
issued pursuant to the public health laws; 

(d) Willfully fail to remove from private property under his or her control at his or her 
own expense, within forty-eight hours after being ordered to do so by the county or district 
public health agency, any nuisance, source of filth, or cause of sickness within the 
jurisdiction and control of the agency whether the person, association, or corporation is the 



25-1-517 



Health 



Title 25 - page 54 



owner, tenant, or occupant of the private property; except that, when the condition is due 
to an act of God, it shall be removed at public expense; or 

(e) Pay, give, present, or otherwise convey to any officer or employee of an agency any 
gift, remuneration, or other consideration, directly or indirectly, that the officer or employee 
is forbidden to receive by the provisions of this part 5. 

(2) It is unlawful for any officer or employee of any agency or member of any county 
or district board of health to accept any gift, remuneration, or other consideration, directly 
or indirectly, for an incorrect or improper performance of the duties imposed upon him or 
her by or on behalf of the agency or by the provisions of this part 5. 

(3) Any person, association, or corporation, or the officers thereof, who violates any 
provision of this section is guilty of a class 1 misdemeanor and, upon conviction thereof, 
shall be punished pursuant to the provisions of section 18-1.3-501, C.R.S. In addition to the 
fine or imprisonment, the person, association, or corporation shall be liable for any expense 
incurred by health authorities in removing any nuisance, source of filth, or cause of 
sickness. Conviction under the penalty provisions of this part 5 or any other public health 
law shall not relieve any person from any civil action in damages that may exist for an 
injury resulting from any violation of the public health laws. 

Source: L. 2008: Entire part R&RE, p. 2048, § 1, effective July 1. 

Editor's note: This section is similar to former § 25-1-514 as it existed prior to 2008. 

ANNOTATION 



Law reviews. For article, "A Review of the 
1959 Constitutional and Administrative Law 
Decisions", see 37 Dicta 81 (1960). 

Annotator's note. Since § 25-1-516 is sim- 
ilar to § 25-1-514 as it existed prior to the 2008 
repeal and reenactment of this part 5, a relevant 
case construing that provision has been included 
in the annotations to this section. 

This section is unlawful delegation of leg- 
islative power to define crime. Section 25-1- 
507(1 )(d), delegating power to local boards of 
health to adopt rules and regulations, and sub- 



section (l)(a), providing that a violation of such 
rules and regulations shall be a misdemeanor, 
constitute an unlawful delegation of power to 
the executive department to define a crime in 
violation of art. Ill, Colo. Const. Casey v. Peo- 
ple, 139 Colo. 89, 336 P2d 308 (1959). 

Only general assembly may declare an act to 
be a crime, and that precious power cannot be 
delegated to others not elected by or responsible 
to the people. Casey v. People, 139 Colo. 89, 
336 P2d 308 (1959). 



25-1-517. Mode of treatment inconsistent with religious creed or tenet. Nothing in 
this part 5 authorizes a county or district board of health to impose on any person any mode 
of treatment inconsistent with the creed or tenets of any religious denomination of which he 
or she is an adherent if the person complies with sanitary and quarantine laws and rules. 

Source: L. 2008: Entire part R&RE, p. 2049, § 1, effective July 1. 

Editor's note: This section is similar to former § 25-1-515 as it existed prior to 2008. 

25-1-518. Nuisances. (1) Removal of nuisances. The county or district board of 
health shall examine all nuisances, sources of filth, and causes of sickness, which, in its 
opinion, may be injurious to the health of the inhabitants, within its town, city, county, city 
and county, or district, and it shall destroy, remove, or prevent the nuisance, source of filth, 
or cause of sickness, as the case may require. 

(2) Unhealthy premises cleaned - structures removed. If any cellar, vault, lot, sewer, 
drain, place, or premises within any city is damp, unwholesome, offensive, or filthy, or is 
covered for any portion of the year with stagnant or impure water, or is in a condition as 
to produce unwholesome or offensive exhalations, the county or district board of health may 
cause the area to be drained, filled up, cleaned, amended, or purified; or may require the 
owner or occupant or person in charge of the lot, premises, or place to perform such duty; 
or may cause the removal to be done by the proper officers of the city. 



Title 25 - page 55 Administration 25- 1-518 

(3) Expense for abating nuisance. If any person or company neglects to remove or 
abate any nuisance or to perform any requirement made by or in accordance with any 
ordinance or resolution of the county or district board of health for the protection of the 
health of the inhabitants and if any expense is incurred by the board in removing or abating 
the nuisance or in causing such duty or requirement to be performed, such expense may be 
recovered by the board in an action against such person or company. In all cases where the 
board incurs any expense for draining, filling, cleaning, or purifying any lot, place, or 
premises, or for removing or abating any nuisance found upon such lot or premises, the 
board, in addition to all other remedies, may provide for the recovery of such expense, 
charge the same or such part thereof as it deems proper to the lot or premises upon or on 
account of which such expense was incurred or from which such nuisance was removed or 
abated, and cause the same to be assessed upon such lot or premises and collected as a 
special assessment. 

(4) Removal of nuisance on private property - penalty. Whenever any nuisance, 
source of filth, or cause of sickness is found on private property, the county or district board 
of health shall order the owner or occupant or the person who has caused or permitted such 
nuisance, at his or her own expense, to remove the same within twenty-four hours. In 
default thereof, he or she shall forfeit a sum not to exceed one hundred dollars at the suit 
of the board of county commissioners of the proper county or the board of the proper city, 
town, or village for the use of the county or district board of health of the city or town where 
the nuisance is found. 

(5) Board to remove - when. If the owner or occupant does not comply with an order 
of the county or district board of health, the board may cause the nuisance, source of filth, 
or cause of sickness to be removed, and all expense incurred thereby shall be paid by the 
owner or occupant or by such other person who has caused or permitted the nuisance, 
source of filth, or cause of sickness. 

(6) Conviction - nuisance to be abated. Whenever any person is convicted of 
maintaining a nuisance that may be injurious to the public health, the court, in its discretion, 
may order the nuisance abated, removed, or destroyed at the expense of the defendant under 
the direction of the county or district board of health of the town, city, county, or district 
where the nuisance is found, and the form of the warrant to the sheriff or other officer may 
be varied accordingly. 

(7) Stay warrant of conviction. The court, on the application of the defendant, may 
order a stay of a warrant issued pursuant to subsection (6) of this section for such time as 
may be necessary, not exceeding six months, to give the defendant an opportunity to remove 
the nuisance upon giving satisfactory security to do so within the time specified in the order. 

(8) Expense of abating. The expense of abating and removing the nuisance pursuant 
to a warrant issued pursuant to subsection (6) of this section shall be collected by the officer 
in the same manner as damages and costs are collected upon execution; except that the 
materials of any buildings, fences, or other things that may be removed as a nuisance may 
be sold by the officer in like manner as goods are sold on execution for the payment of 
debts. The officer may apply the proceeds of the sale to defray the expenses of the removal 
and shall pay over the balance thereof, if any, to the defendant upon demand. If the proceeds 
of the sale are not sufficient to defray the expenses incurred pursuant to this subsection (8), 
the sheriff shall collect the residue thereof as provided in subsection (3) of this section. 

(9) Refusal of admittance to premises, (a) Whenever a county or district board of 
health finds it necessary for the preservation of the lives or health of the inhabitants to enter 
any building, car, or train of cars in its town, city, county, or district for the purpose of 
examining and abating, removing, or preventing any nuisance, source of filth, or cause of 
sickness and is refused entry, any member of the board may make complaint under oath to 
the county court of his or her county stating the facts of the case as far as he or she has 
knowledge thereof. 

(b) The court may thereupon issue a warrant directed to the sheriff commanding him or 
her to take sufficient aid and, being accompanied by any two or more members of the county 
or district board of health, during daylight hours, to return to the place where the nuisance, 
source of filth, or cause of sickness complained of may be and destroy, remove, or prevent 



25-1-519 



Health 



Title 25 - page 56 



the nuisance, source of filth, cause of sickness, or danger to life or limb under the direction 
of the members of the board of health. 

(10) Damages occasioned by nuisance - action. Any person injured either in his or her 
comfort or in the enjoyment of his or her estate by any nuisance may have an action for 
damages sustained thereby. 

Source: L. 2008: Entire part R&RE, p. 2049, § 1, effective July 1. L. 2009: (1) 

amended, (SB 09-292), ch. 369, p. 1970, § 83, effective August 5. 

Editor's note: The provisions of this section are similar to provisions of several former sections 
as they existed prior to 2008. For a detailed comparison, see the comparative tables located in the back 
of the index. 

ANNOTATION 



Annotator's note. Since § 25-1-518 is sim- 
ilar to § 25-1-613 as it existed prior to the 2008 
repeal and reenactment of this part 5, relevant 
cases construing that provision have been in- 
cluded in the annotations to this section. 

Only nuisances per se may be removed or 
abated summarily. City of Denver v. Mullen, 7 
Colo. 345, 3 P. 693 (1884). 



Compensation required for property mis- 
takenly destroyed as nuisance. If property is 
destroyed under a mistaken belief that it is a 
nuisance, when in fact it is not a nuisance, it is 
taken for a public use, and the loss to the owner 
should be made good. McMahon v. City of 
Telluride, 79 Colo. 281, 244 P. 1017 (1926). 



25-1-519. Existing intergovernmental agreements. Nothing in this part 5 shall void 
the terms of any intergovernmental agreement concerning public health entered into as of 
July 1, 2008, so long as all core and essential public health services continue to be provided. 

Source: L. 2008: Entire part R&RE, p. 2051, § 1, effective July 1. 



25-1-520. Clean syringe exchange programs - approval - reporting requirements - 
repeal. (1) A county public health agency or district public health agency may request 
approval from its county board of health or district board of health, referred to in this section 
as the "board", for a clean syringe exchange program operated by the agency or by a 
nonprofit organization with which the agency contracts to operate the clean syringe 
exchange program. Prior to approving or disapproving any such optional program, the 
board shall consult with the agency and interested stakeholders concerning the establish- 
ment of the clean syringe exchange program. Interested stakeholders shall include, but need 
not be limited to, local law enforcement agencies, district attorneys, substance abuse 
treatment providers, persons in recovery, nonprofit organizations, hepatitis C and HIV 
advocacy organizations, and members of the community. The board and interested stake- 
holders shall consider, at a minimum, the following issues: 

(a) The scope of the problem being addressed and the population the program would 
serve; 

(b) Concerns of the law enforcement community; and 

(c) The parameters of the proposed program, including methods for identifying pro- 
gram workers and volunteers. 

(2) Each proposed clean syringe exchange program shall, at a minimum, have the 
ability to: 

(a) Provide an injection drug user with the information and the means to protect himself 
or herself, his or her partner, and his or her family from exposure to blood-borne disease 
through access to education, sterile injection equipment, voluntary testing for blood-borne 
diseases, and counseling; 

(b) Provide thorough referrals to facilitate entry into drug abuse treatment, including 
opioid substitution therapy; 

(c) Encourage usage of medical care and mental health services as well as social 
welfare and health promotion; 



Title 25 - page 57 Administration 25- 1-719 

(d) Provide safety protocols and classes for the proper handling and disposal of 
injection materials; 

(e) Plan and implement the clean syringe exchange program with the clear objective of 
reducing the transmission of blood-borne diseases within a specific geographic area; and 

(f) Develop a timeline for the proposed program and for the development of policies 
and procedures. 

(3) The board may approve or disapprove the proposed clean syringe exchange 
program based on the results of the meetings held pursuant to subsection (1) of this section. 

(4) If the board approves a clean syringe exchange program that is operated through a 
contract with a nonprofit organization, the contract shall be subject to annual review and 
shall be renewed only if the board approves the contract after consultation with the county 
or district public health agency and interested stakeholders as described in subsection (1) of 
this section. 

(5) One or more counties represented on a district board of health may at any time opt 
out of a clean syringe exchange program proposed or approved pursuant to this section. 

(6) (a) On or before July 1, 2011, and on or before July 1 each year thereafter, each 
board that authorizes a clean syringe exchange program pursuant to this section shall submit 
a report to the department of public health and environment concerning the results of the 
program. On or before September 1, 2011, and on or before September 1 each year 
thereafter, the department of public health and environment shall submit a report to the 
health and human services committees of the house of representatives and the senate, or any 
successor committees, summarizing the reports received from boards pursuant to this 
paragraph (a). 

(b) This subsection (6) is repealed, effective July 1, 2014. 

Source: L. 2010: Entire section added, (SB 10-189), ch. 272, p. 1253, § 3, effective 
August 11. 

PART 6 

LOCAL BOARDS OF HEALTH 

25-1-601 to 25-1-667. (Repealed) 

Source: L. 2008: Entire part repealed, p. 2051, § 3, effective July 1. 

Editor's note: This part 6 was numbered as article 3 of chapter 66, C.R.S. 1963. For amendments 
to this part 6 prior to its repeal in 2008, consult the Colorado statutory research explanatory note and 
the table itemizing the replacement volumes and supplements to the original volume of C.R.S. 1973 
beginning on page vii in the front of this volume. The provisions of this part 6 were relocated to part 
5 of this article. For the location of specific provisions, see the editor's notes following each section 
in said part 5 and the comparative tables located in the back of the index. 

PART 7 

REGIONAL HEALTH DEPARTMENTS 

25-1-701 to 25-1-719. (Repealed) 

Source: L. 2008: Entire part repealed, p. 2051, § 3, effective July 1. 

Editor's note: This part 7 was numbered as article 37 of chapter 66, C.R.S. 1963. For amendments 
to this part 7 prior to its repeal in 2008, consult the Colorado statutory research explanatory note and 
the table itemizing the replacement volumes and supplements to the original volume of C.R.S. 1973 
beginning on page vii in the front of this volume. 



25-1-801 Health Title 25 - page 58 

PARTS 

PATIENT RECORDS 

Law reviews: For article, "Rights to and Disclosure of Medical Information: HIPAA and Colorado 
Law", see 33 Colo. Law. 101 (October 2004). 

25-1-801. Patient records in custody of health care facility. (1) (a) Every patient 
record in the custody of a health facihty licensed or certified pursuant to section 25-1.5-103 
(1) or article 3 of this title, or both, or any entity regulated under title 10, C.R.S., providing 
health care services, as defined in section 10-16-102 (22), C.R.S., directly or indirectly 
through a managed care plan, as defined in section 10-16-102 (26.5), C.R.S., or otherwise 
shall be available for inspection to the patient or the patient's designated representative 
through the attending health care provider or such provider's designated representative at 
reasonable times and upon reasonable notice, except records pertaining to mental health 
problems or notes by a physician that, in the opinion of a hcensed physician who practices 
psychiatry and is an independent third party, would have significant negative psychological 
impact upon the patient. Such independent third-party physician shall consult with the 
attending physician prior to making a determination with regard to the availability for 
inspection of any patient record and shall report in writing findings to the attending 
physician and to the custodian of said record. A summary of records pertaining to a patient's 
mental health problems may, upon written request and signed and dated authorization, be 
made available to the patient or the patient' s designated representative following termina- 
tion of the treatment program. 

(b) (I) Following any treatment, procedure, or health care service rendered by a health 
facility licensed or certified pursuant to section 25-1.5-103 (1) or article 3 of this title, or 
both, or by an entity regulated under title 10, C.R.S., providing health care services, as 
defined in section 10-16-102 (22), C.R.S., directly or indirectly through a managed care 
plan, as defined in section 10-16-102 (26.5), C.R.S., or otherwise, copies of said records, 
including X rays, shall be furnished to the patient upon submission of a written authori- 
zation-request for records, dated and signed by the patient, and upon the payment of the 
reasonable costs. 

(II) In the event that a licensed health care professional determines that a copy of any 
X ray, mammogram, CT SCAN, MRI, or other film is not sufficient for diagnostic or other 
treatment purposes, the health facility or entity shall make the original of any such film 
available to the patient or another health care professional or facility as specifically directed 
by the patient pursuant to a written authorization-request for films and upon the payment of 
the reasonable costs for such film. If a health facility releases an original film pursuant to 
this subparagraph (II), it shall not be responsible for any loss, damage, or other conse- 
quences as a result of such release. Any original X ray, mammogram, CT SCAN, MRI, or 
other film made available pursuant to this subparagraph (II) shall be returned upon request 
to the lending facility within thirty days. 

(c) The hospital or related facility or institution shall post in conspicuous public places 
on the premises a statement of the requirements set forth in paragraphs (a) and (b) of this 
subsection (1) and shall make available a copy of said statement to each patient upon 
admission. 

(d) Nothing in this section shall be construed to require a person responsible for the 
diagnosis or treatment of sexually transmitted infections or addiction to or use of drugs in 
the case of minors pursuant to sections 25-4-402 (4) and 13-22-102, C.R.S., to release 
patient records of such diagnosis or treatment to a parent, guardian, or person other than the 
minor or his or her designated representative. 

(2) All requests by patients for inspection of their medical records made under this 
section shall be noted with the time and date of the patient's request, and the time and date 
of inspection noted by the attending health care provider or his designated representative. 
The patient shall acknowledge the fact of his inspection by dating and signing his record 
file. 



Title 25 - page 59 



Administration 



25-1-802 



(3) Nothing in this section shall apply to any nursing institution conducted by or for the 
adherents of any well-recognized church or religious denomination for the purpose of 
providing facilities for the care and treatment of the sick who depend exclusively upon 
spiritual means through prayer for healing and the practice of the religion of such church 
or denomination. 

(4) For the purposes of this section, medical information transmitted during the 
delivery of health care via telemedicine, as defined in section 12-36-106 (1) (g), C.R.S., is 
part of the patient's medical record maintained by the health care facility. 

Source: L. 76: Entire part added, p. 648, § 1, effective July 1. L. 83: (l)(a) R&RE, p. 
1040, § 1, effective May 20. L. 97: (l)(a) and (l)(b) amended, p. 348, § 1, effective April 
19. L. 2001: (4) added, p. 1163, § 10, effective January 1, 2002. L. 2003: (l)(a) and 
(l)(b)(I) amended, p. 708, § 36, effective July 1. L. 2009: (l)(d) amended, (SB 09-179), 
ch. 112, p. 475, § 20, effective April 9. 

Cross references: For the legislative declaration contained in the 2001 act enacting subsection (4), 
see section 1 of chapter 300, Session Laws of Colorado 2001. 

ANNOTATION 



Law reviews. For article, "The Authorization 
to Release Medical Information Form: Its Gen- 
esis and Usage", see 11 Colo. Law. 1179 (1982). 
For article, "Legislative Update", see 12 Colo. 
Law. 1251 (1983). 

Exception to broad disclosure. This section 
can be read consistendy with former § 27-10- 
116 (l)(a) as a specific exception to a general 
policy of broad disclosure and is not unconsd- 
tutional on its face as it operates with the short- 
term commitment procedure. Brown v. Jensen, 
572 F Supp. 193 (D. Colo. 1983). 

The phrase "the reasonable costs" of pro- 
viding copies of medical records, as used in 



subsection (l)(b), does not indicate that pro- 
viders may only charge for the singular costs 
directly incurred in the physical act of copy- 
ing. The term "costs" is not singular and is not 
limited to the costs of supplies and the labor of 
copying. Colo. Consumer Health Initiative v. 
Colo. Bd. of Health, 240 R3d 525 (Colo. App. 
2010). 

"Reasonable costs" may include the costs 
inherent in record inspection. Colo. Consumer 
Health Initiative v. Colo. Bd. of Health, 240 R3d 
525 (Colo. App. 2010). 



25-1-802. Patient records in custody of individual health care providers. 

(1) (a) Every patient record in the custody of a podiatrist, chiropractor, dentist, doctor of 
medicine, doctor of osteopathy, nurse, optometrist, audiologist, acupuncturist, direct-entry 
midwife, or physical therapist required to be licensed under title 12, C.R.S., or a person 
practicing psychotherapy under the provisions of article 43 of title 12, C.R.S., except 
records pertaining to mental health problems, shall be available to the patient upon 
submission of a written authorization-request for inspection of records, dated and signed by 
the patient, at reasonable times and upon reasonable notice. A summary of records 
pertaining to a patient's mental health problems may, upon written request and signed and 
dated authorization, be made available to the patient or the patient's designated represen- 
tative following termination of the treatment program. 

(b) (I) A copy of such records, including X rays, shall be made available to the patient 
or the patient' s designated representative, upon written authorization-request for a copy of 
such records, dated and signed by the patient, upon reasonable notice and payment of the 
reasonable costs. 

(II) In the event that a licensed health care professional determines that a copy of any 
X ray, mammogram, CT SCAN, MRI, or other film is not sufficient for diagnostic or other 
treatment purposes, the podiatrist, chiropractor, dentist, doctor of medicine, doctor of 
osteopathy, nurse, optometrist, audiologist, acupuncturist, direct-entry midwife, or physical 
therapist required to be licensed under tide 12, C.R.S., or, subject to the provisions of 
section 25-1-801 (1) (a) and paragraph (a) of this subsection (1), the person practicing 
psychotherapy under the provisions of article 43 of title 12, C.R.S., shall make the original 
of any such film available to the patient or another health care professional or facility as 



25-1-803 



Health 



Title 25 - page 60 



specifically directed by the patient pursuant to a written authorization-request for films and 
upon the payment of the reasonable costs for such film. If a practitioner releases an original 
film pursuant to this subparagraph (II), the practitioner shall not be responsible for any loss, 
damage, or other consequences as a result of such release. Any original X ray, mammogram, 
CT SCAN, MRI, or other film made available pursuant to this subparagraph (II) shall be 
returned upon request to the lending practitioner within thirty days. 

(2) Nothing in this section shall be construed to require a person responsible for the 
diagnosis or treatment of sexually transmitted infections or addiction to or use of drugs in 
the case of minors pursuant to sections 25-4-402 (4) and 13-22-102, C.R.S., to release 
patient records of such diagnosis or treatment to a parent, guardian, or person other than the 
minor or his or her designated representative. 

(3) For purposes of this section, "patient record" does not include a doctor's office 
notes. 

(4) All requests by patients for inspection of their medical records made under this 
section shall be noted with the time and date of the patient's request and the time and date 
of inspection noted by the health care provider or his designated representative. The patient 
shall acknowledge the fact of his inspection by dating and signing his record file. 

(5) For the purposes of this section, medical information transmitted during the 
delivery of health care via telemedicine, as defined in section 12-36-106 (1) (g), C.R.S., is 
part of the patient's medical record maintained by a health care provider. 

Source: L. 76: Entire part added, p. 649, § 1, effective July 1. L. 97: (1) amended, p. 
349, § 2, effective April 19; (l)(a) amended, p. 1032, § 69, effective August 6. L. 2001: 
(5) added, p. 1163, § 11, effective January 1, 2002. L. 2009: (2) amended, (SB 09-179), 
ch. 112, p. 475, § 21, effective April 9. 

Cross references: For the legislative declaration contained in the 2001 act enacting subsection (5), 
see section 1 of chapter 300, Session Laws of Colorado 2001. 

ANNOTATION 



The phrase "mental health problems" 
means psychiatric or psychological problems. 

The phrase does not include general profes- 
sional counseling, addressing life skill building, 
decision making, and problem solving, unre- 
lated to psychiatric or psychological problems. 
Therefore, such records are available to the pa- 
tient under this section. Dauwe v. Musante, 122 
P.3d 15 (Colo. App. 2004). 

The phrase "the reasonable costs" of pro- 
viding copies of medical records, as used in 
subsection (l)(b), does not indicate that pro- 



viders may only charge for the singular costs 
directly incurred in the physical act of copy- 
ing. The term "costs" is not singular and is not 
limited to the costs of supplies and the labor of 
copying. Colo. Consumer Health Initiative v. 
Colo. Bd. of Health, 240 P.3d 525 (Colo. App. 
2010). 

"Reasonable costs" may include the costs 
inherent in record inspection. Colo. Consumer 
Health Initiative v. Colo. Bd. of Health, 240 R3d 
525 (Colo. App. 2010). 



25-1-803. Effect of this part 8 on similar rights of a patient. ( 1 ) Nothing in this part 
8 shall be construed so as to: 

(a) Limit the right of a patient or the patient's designated representative to inspect the 
patient's medical or mental health data pursuant to section 24-72-204 (3) (a) (I), C.R.S.; or 

(b) Limit a right to inspect the patient's records which is otherwise granted by state 
statute to the patient or his designated representative. 



Source: L. 76: Entire part added, p. 650, § 1, effective July 1. L. 97: (l)(a) amended, 
p. 350, § 3, effective April 19. 



Title 25 - page 61 Administration 25- 1 -902 

PART 9 
ADVISORY COMMISSION ON FAMILY MEDICINE 

25-1-901. Legislative declaration. (1) The general assembly hereby finds and de- 
clares that: 

(a) Physicians engaged in family medicine are in critically short supply in this state; 

(b) Because of the distribution of such physicians, many rural and urban areas of the 
state are underserved; 

(b.l) A significant portion of the state population is medically underserved because of 
indigency; 

(b.2) Family physicians provide health care to all segments of the population; 

(c) The provision of more competent family physicians is a public purpose of great 
importance; and 

(d) The creation of an advisory commission on family medicine is a desirable, 
necessary, and economic means of addressing the needs described in paragraphs (a) and (b) 
of this subsection (1). 

Source: L. 77: Entire part added, p. 1271, § 1, effective July 1. L. 83: (l)(b.l) and 
(l)(b.2) added, p. 1041, § 1, effective May 20. 

25-1-902. Commission created - composition - terms of office. (1) There is hereby 
created, in the department of health, the commission on family medicine, referred to in this 
part 9 as the "commission". Appointments of members made to take effect on January 1, 
1983, shall be made in accordance with section 24-1-135, C.R.S. No more than eight 
members of the commission shall be members of the same major political party. A vacancy 
on the commission occurs whenever any health care consumer member moves out of the 
congressional district from which he was appointed. A health care consumer member who 
moves out of such congressional district shall promptly notify the governor of the date of 
such move, but such notice is not a condition precedent to the occurrence of the vacancy. 
The governor shall fill the vacancy by appointment for the unexpired term. The commission 
shall consist of members determined as follows: 

(a) The dean of the university of Colorado school of medicine or his designated 
representative; 

(b) The director of all family medicine programs in the state accredited by the 
accreditation council on graduate medical education of the American medical association or 
the American osteopathic association; 

(c) A representative of the Colorado academy of family physicians; and 

(d) A health care consumer to be appointed by the governor from each congressional 
district in the state. 

(2) The members appointed under paragraph (d) of subsection ( 1 ) of this section shall 
serve at the pleasure of the governor and shall serve for three-year terms. 

(3) The commission shall elect a chairman and a vice-chairman from among its 
members. Administrative, staff, and clerical services shall be provided to the commission by 
the Colorado academy of family physicians, as determined necessary by the academy. 
Members of the commission shall serve without compensation, but members described in 
paragraphs (b), (c), and (d) of subsection (1) of this section shall be entitled to their actual 
and necessary expenses incurred in the performance of their duties. The commission shall 
meet on call of the chairman, but not less than once every three months. A majority of the 
members of the commission constitutes a quorum for the transaction of business. 

Source: L. 77: Entire part added, p. 1271, § 1, effective July 1. L. 79: IP(1) and (3) 
amended, p. 1001, § 1, effective July 1. L. 82: IP(1) amended, p. 356, § 16, effective April 
30. L. 83: IP(1), (l)(b), (2), and (3) amended, p. 1041, § 2, effective May 20. L. 89: IP(1) 
amended, p. 1146, § 1, effective April 6. 



25- 1 -903 Health Title 25 - page 62 

25-1-903. Duties of commission. (1) The commission shall: 

(a) Assure that family medicine residency program standards are equal to or more 
stringent than the standards established by the accreditation council on graduate medical 
education of the American medical association or the American osteopathic association for 
residency training in family medicine; 

(b) In cooperation with the dean of the school of medicine, approve and recommend 
allocation of any funds which are identified and appropriated in the general appropriation 
bill as a line item for any community family medicine residency training program; 

(c) Monitor the state's family medicine residency programs and recommend from time 
to time that the general assembly appropriate funds for said programs; 

(d) Locate specific areas of the state which are underserved by family physicians and 
determine the priority of need among such areas; 

(e) Offer to the general assembly alternative ideas on providing medical care to the 
medically indigent in the state. 

(2) Repealed. 

Source: L. 77: Entire part added, p. 1272, § 1, effective July 1. L. 83: (l)(a) and (l)(b) 
amended and (l)(e) added, p. 1042, § 3, effective May 20; (2) amended, p. 839, § 59, 
effective July 1. L. 96: (2) repealed, p. 1253, § 139, effective August 7. 

Cross references: For the legislative declaration contained in the 1996 act amending this section, 
see section 1 of chapter 237, Session Laws of Colorado 1996. 

25-1-904. Sunset review. (Repealed) 

Source: L. 77: Entire part added, p. 1272, § 1, effective July 1. L. 79: Entire section 
amended, p. 1001, § 2, effective July 1. L. 83: Entire section amended, p. 1042, § 4, 
effective May 20. L. 86: Entire section R&RE, p. 420, § 41, effective March 26. L. 89: 
Entire section repealed, p. 1147, § 3, effective April 6. 

PART 10 

CHILD CARE PROGRAMS IN NURSING HOME FACILITIES 

25-1-1001. Legislative declaration. The general assembly hereby finds that the oper- 
ation of child care centers in nursing home facilities is desirable because the benefit to 
nursing home facility employees in having on-location child care will improve the quality 
of care in nursing home facilities by stabilizing the nursing home work force and because 
the general public, especially in rural areas, will benefit from the increased availability of 
day care centers in their communities. The general assembly also finds that the operation of 
child care centers in nursing home facilities is desirable because the intergenerational 
contact has been proven to be beneficial to the health and well-being of elderly persons and, 
therefore, will improve the quality of life of elderly residents in nursing home facilities and 
because the intergenerational contact will be beneficial to the children as well. The general 
assembly, therefore, declares that the intent of this part 10 is to encourage the development 
of child care centers in nursing home facilities by encouraging the creation of private grants 
to provide funds to start such centers and by requiring the state agencies which license 
nursing home facilities and child care centers to study and recommend statutory and 
regulatory changes to facilitate and encourage the development of child care centers in 
nursing home facilities. 

Source: L. 88: Entire part added, p. 1003, § 1, effective April 28. 

25-1-1002. Definitions. As used in this part 10, unless the context otherwise requires: 
(1) "Nursing home facility" means a facility which provides skilled nursing home 
services or intermediate care nursing home services. 



Title 25 - page 63 Administration 25-1-1 004 

Source: L. 88: Entire part added, p. 1004, § 1, effective April 28. 

25-1-1003. Grant program - requirements - use of medical assistance funds pro- 
hibited. (1) The department of public health and environment may encourage the 
development of a private grant program to provide start-up funds to nursing home facilities 
for the purpose of establishing child care centers located in such nursing home facilities. 

(2) The state board of health, after consultation with the division in the department of 
human services involved in licensing child care centers and if the committee formed in 
section 25-1-1004 recommends the establishment of child care facilities in nursing homes, 
shall promulgate reasonable rules and regulations establishing any necessary requirements 
for operating a day care center in a nursing home facility. Such rules and regulations shall 
include, but need not be limited to, the following: 

(a) Requirements for the operation of a safe and good-quality child care operation in the 
nursing home facility or upon the nursing home facility's grounds, which shall include: 

(I) Precautions required to be taken to ensure that all staff and residents who will 
participate in the intergenerational programs have not been involved in incidents of sexual 
abuse or child abuse; 

(II) Requirements relating to the ability to properly care for the children; 

(III) Child care ratios of staff to children; 

(IV) Requirements relating to the constant supervision of the children by staff members 
and not by nursing home residents; 

(V) Life safety and fire regulations; 

(b) Requirements on the amount and type of liability insurance necessary to insure the 
risks associated with the child care operation; 

(c) Requirements on the ways in which the nursing home residents may be involved in 
the child care center and the requirement that the participation of nursing home residents in 
intergenerational activities with the children in the child care operation shall be on a 
voluntary basis; 

(d) Requirements that any fees assessed to the employees of the nursing home facility 
whose children participate in the child care program will be based on a sliding scale; 

(e) Requirements that the participation of employees of the nursing home facility in the 
enrollment of their children in the intergenerational day care program of the nursing home 
facility shall be on a voluntary basis. 

(3) No medical assistance funds under the "Colorado Medical Assistance Act", articles 
4, 5, and 6 of title 25.5, C.R.S., shall be used to subsidize the cost of operating a day care 
center or day care program in a nursing home facility. 

Source: L. 88: Entire part added, p. 1004, § 1, effective April 28. L. 94: (1) and IP(2) 
amended, pp. 2746, 2702, §§ 395, 255, effective July 1. L. 2006: (3) amended, p. 2014, 
§ 85, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection (1) 
and the introductory portion to subsection (2), see section 1 of chapter 345, Session Laws of Colorado 
1994. 

25-1-1004. Study of statutes and rules and regulations pertaining to nursing home 
facilities and day care centers. ( 1 ) The department of public health and environment and 
the department of human services, in conjunction with representatives of the nursing home 
industry, child care operators, and experts on child care programs in nursing home facilities, 
shall examine and study the existing statutes and rules and regulations concerning the 
licensing of child care centers and of nursing home facilities to determine what statutory or 
regulatory changes or both would make it easier for a nursing home facility to operate a 
child care center. The study shall also include an examination of the advantages and 
disadvantages of operating such intergenerational programs and the most appropriate and 
practical ways to design such intergenerational child care programs which are beneficial 
both to the children and to the elderly persons. 



25-1-1100.2 Health Title 25 - page 64 

(2) The study conducted by the department of public health and environment and the 
department of human services shall include, but need not be limited to, consideration of the 
following: 

(a) The establishment of new rules and regulations by the department of public health 
and environment and the department of human services which would allow nursing home 
facilities to operate a child care operation in the nursing home facilities; 

(b) A coordinated licensure program to license a child care operation in a nursing home 
facility which would be based on rules and regulations designed specifically for the 
operation of a child care center in a nursing home facility. 

(3) Repealed. 

(4) The department of public health and environment and the department of human 
services shall comply with the requirements of this part 10 within the current appropriation 
established for each department. No request for appropriations shall be made to the general 
assembly for the implementation of this part 10. 

Source: L. 88: Entire part added, p. 1005, § 1, effective April 28. L. 94: (1), IP(2), 
(2)(a), (3), and (4) amended, p. 2747, § 396, effective July 1. L. 96: (3) repealed, p. 1257, 
§ 147, effective August 7. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), the introductory portion to subsection (2), and subsections (2)(a), (3), and (4), see section 1 of 
chapter 345, Session Laws of Colorado 1994. For the legislative declaration contained in the 1996 act 
amending this section, see section 1 of chapter 237, Session Laws of Colorado 1996. 

PART 11 

DRUG ABUSE PREVENTION, EDUCATION, AND TREATMENT 

25-1-1100.2 to 25-1-1112. (Repealed) 

Source: L. 2010: Entire part repealed, (SB 10-175), ch. 188, p. 675, § 1, effective April 
29. 

Editor's note: (1) This part 11 was added in 1991. For amendments to this part 11 prior to its 
repeal in 2010, consult the Colorado statutory research explanatory note and the table itemizing the 
replacement volumes and supplements to the original volume of C.R.S. 1973 beginning on page vii 
in the front of this volume. 

(2) The provisions of this part 11 were relocated to article 82 of title 27 in 2010. 

PART 12 
MEDICAL RECORD CONFIDENTIALITY 

25-1-1201. Legislative declaration. The general assembly hereby finds, determines, 
and declares that maintaining the confidentiality of medical records is of the utmost 
importance to the state and of critical importance to patient privacy for high quality medical 
care. Most people in the United States consider confidentiality of health information 
important and worry that the increased computerization of health records may result in 
inappropriate disclosure of such records. Patients have a strong interest in preserving the 
privacy of their personal health information, but they also have an interest in medical 
research and other efforts by health care organizations to improve the medical care they 
receive. How best to preserve confidentiality within a state health information infrastructure 
is an important discussion that is affected by recent regulations promulgated by the federal 
department of health and human services related to the electronic storage of health 
information. The purpose of this part 12 is to index the provisions that govern medical 



Title 25 - page 65 Administration 25-1-1 202 

record confidentiality to facilitate locating the law concerning the confidentiality of medical 
records and health information. It is not intended to expand, narrow, or clarify existing 
provisions. 

Source: L. 2001: Entire part added, p. 828, § 5, effective August 8. 

25-1-1202. Index of statutory sections regarding medical record confidentiality 
and health information. (1) Statutory provisions concerning policies, procedures, and 
references to the release, sharing, and use of medical records and health information include 
the following: 

(a) Section 10-16-1003, C.R.S., concerning use of information by health care coopera- 
tives; 

(b) Section 8-43-404, C.R.S., concerning examinations by a physician or chiropractor 
for the purposes of workers' compensation; 

(c) Section 8-43-501, C.R.S., concerning utilization review related to workers' com- 
pensation; 

(d) Section 8-73-108, C.R.S., concerning the award of benefits for unemployment 
compensation benefits; 

(e) Section 10-3-1104.7, C.R.S., concerning the confidentiality and use of genetic 
testing information; 

(f) Section 10-16-113, C.R.S., concerning the procedures related to the denial of health 
benefits by an insurer; 

(g) Section 10-16-113.5, C.R.S., concerning the use of independent external review 
when health benefits have been denied; 

(h) Section 10-16-423, C.R.S., concerning the confidentiality of medical information in 
the custody of a health maintenance organization; 

(i) Section 12-32-108.3, C.R.S., concerning disciplinary actions against podiatrists; 

(j) Section 12-33-126, C.R.S., concerning disciplinary actions against chiropractors; 

(k) Section 12-35-129, C.R.S., concerning disciplinary actions against dentists and 
dental hygienists; 

(1) Section 12-36-118, C.R.S., concerning discipHnary actions against physicians; 

(m) Section 12-36-135 (1), C.R.S., concerning reporting requirements for physicians 
pertaining to certain injuries; 

(n) Section 12-36.5-104, C.R.S., concerning professional review committees for phy- 
sicians; 

(o) Section 12-36.5-104.4, C.R.S., concerning hospital professional review commit- 
tees; 

(p) Section 12-37.5-104, C.R.S., concerning reporting requirements by physicians 
related to abortions for minors; 

(q) Section 12-38-116.5, C.R.S., concerning discipHnary proceedings against a practi- 
cal nurse, a professional nurse, or a psychiatric technician; 

(r) Section 12-43-218, C.R.S., concerning the disclosure of confidential communica- 
tions by a mental health professional; 

(s) Section 12-43-224 (4), C.R.S., concerning disciplinary proceedings against a mental 
health professional; 

(t) Section 13-21-110, C.R.S., concerning confidentiality of information, data, reports, 
or records of a utilization review committee of a hospital or other health care facility; 

(u) Section 13-21-117, C.R.S., concerning civil Hability of a mental health professional, 
mental health hospital, community mental health center, or clinic related to a duty to warn 
or protect; 

(v) Sections 13-22-101 to 13-22-106, C.R.S., concerning the age of competence for 
certain medical procedures; 

(w) Section 13-64-502, C.R.S., concerning civil liability related to genetic counseling 
and screening and prenatal care, or arising from or during the course of labor and delivery, 
or the period of postnatal care in a health institution; 



25- 1 - 1 202 Health Title 25 - page 66 

(x) Section 13-80-103.7, C.R.S., concerning a limited waiver of medical information in 
civil actions related to sexual assault or sexual offenses against a child; 

(y) Section 13-90-107 (1) (d), C.R.S., concerning when a physician, surgeon, or 
registered professional nurse may testify related to the care and treatment of a person; 

(z) Section 14-10-124, C.R.S., concerning the best interests of a child for the purposes 
of a separation or dissolution of marriage; 

(aa) Section 14-10-127, C.R.S., concerning the allocation of parental responsibilities 
with respect to a child; 

(bb) Section 17-27.1-101 (4), C.R.S., concerning nongovernmental facilities for of- 
fenders and the waiver of confidential information; 

(cc) Section 18-3-203 (1) (f.5), C.R.S., concerning assault in the second degree and the 
availability of medical testing for certain circumstances; 

(dd) Section 18-4-412, C.R.S., concerning theft of medical records or medical infor- 
mation; 

(ee) Sections 18-6-101 to 18-6-104 C.R.S., concerning a justified medical termination 
of pregnancy; 

(ee.5) Section 18-18-406.3, C.R.S., concerning medical marijuana patient records; 

(ff) Section 18-18-503, C.R.S,, concerning cooperative agreements to control substance 
abuse; 

(gg) Section 19-3-304, C.R.S., concerning persons required to report child abuse or 
neglect; 

(hh) Section 19-3-305, C.R.S., concerning postmortem investigation related to the 
death of a child; 

(ii) Section 19-3-306, C.R.S. , concerning evidence of abuse or neglect of a child; 

(jj) Section 19-5-103 (2), C.R.S., concerning relinquishment of rights concerning a 
child; 

(kk) Section 19-5-305, C.R.S., concerning access to adoption records; 

(11) Section 22-1-123 (5), C.R.S., concerning the protection of student data; 

(mm) Sections 22-32-109.1 (6) and 22-32-109.3 (2), C.R.S., concerning specific pow- 
ers and duties of the state board of education; 

(nn) Section 22-64-216, C.R.S., concerning confidentiality of records maintained by 
school district retirement plans; 

(oo) Section 24-51-213, C.R.S., concerning confidentiality of records maintained by 
the public employees' retirement association; 

(pp) Section 24-72-204 (3), C.R.S., concerning public records not open to public 
inspection; 

(qq) Section 25-1-122, concerning reporting of certain diseases and conditions for 
investigation of epidemic and communicable diseases, morbidity and mortality, cancer in 
connection with the statewide cancer registry, environmental and chronic diseases, sexually 
transmitted infections, tuberculosis, and rabies and mammal bites by the department of 
public health and environment; 

(rr) Section 25-1-124 (2), concerning health care facilities and reporting requirements; 

(ss) Sections 27-81-110 and 27-81-113, C.R.S., concerning the treatment of intoxicated 
persons; 

(tt) Section 25-1-801, concerning patient records in the care of a health care facility; 

(uu) Section 25-1-802, concerning patient records in the care of individual health care 
providers; 

(vv) Sections 27-82-106 and 27-82-109, C.R.S., concerning the treatment of drug 
abusers; 

(vv.5) Section 25-1.5-106, concerning the medical marijuana program; 

(ww) Section 25-2-120, concerning reports of electroconvulsive treatment; 

(xx) Section 25-3-109, concerning quality management functions of health care facil- 
ities licensed by the department of public health and environment; 



Title 25 - page 67 Administration 25- 1 - 1 203 

(yy) Section 25-3.5-501, concerning records maintained by ambulance services and 
emergency medical service providers; 

(zz) Section 25-3.5-704 (2) (d) and (2) (f), concerning the designation of emergency 
medical facilities and the statewide trauma system; 

(aaa) Section 25-4-402 (4), concerning the reporting of sexually transmitted infections; 

(bbb) Section 25-4-1003, concerning newborn screening programs and genetic coun- 
seling; 

(ccc) Sections 25-4-1402 to 25-4-1407, concerning reporting and investigation of the 
human immunodeficiency virus; 

(ddd) Section 25-4-1705, concerning immunization information; 

(eee) Section 25-4-1905, concerning records collected related to Gulf War syndrome; 

(fff) Section 25-32-106, concerning the release of medical information to a poison 
control service provider; 

(ggg) Section 26-3.1-102 (2), C.R.S., concerning reporting requirements related to 
at-risk adults; 

(hhh) Section 26-1 1 .5-108, C.R.S., concerning the long-term ombudsman program and 
access to medical records; 

(iii) Section 27-65-103 (2), C.R.S., concerning voluntary applications for mental health 
services; 

(jjj) Sections 27-65-121 (2) and 27-65-122, C.R.S., concerning records related to 
mental health services for minor children; 

(kkk) Section 30-10-606 (6), C.R.S., concerning postmortem investigations and re- 
cords; 

(111) Section 35-9-109, C.R.S., concerning confidentiality of information released to the 
commissioner of agriculture related to human exposure to pesticide applications; 

(mmm) Section 42-2-112, C.R.S., concerning information supplied to the department 
of revenue for the purpose of renewing or obtaining a license to operate a motor vehicle; 
and 

(nnn) Section 12-42.5-406, C.R.S., concerning information entered into the prescrip- 
tion drug monitoring program database. 

Source: L. 2001: Entire part added, p. 829, § 5, effective August 8. L. 2002: (l)(fff) 
amended, p. 428, § 6, effective July 1. L. 2003: (l)(ii) amended, p. 1997, § 46, effective 
May 22. L. 2004: (l)(k) amended, p. 857, § 3, effective July 1; (l)(a) amended, p. 1010, 
§ 21, effective August 4. L. 2009: (l)(qq) and (l)(aaa) amended, (SB 09-179), ch. 112, p. 
475, § 22, effective April 9. L. 2010: (l)(ss), (l)(vv), (l)(iii), and (l)(jjj) amended, (SB 
10-175), ch. 188, p. 797, § 57, effective April 29; (l)(vv.5) added, (SB 10-109), ch. 356, 
p. 1696, § 2, effective June 7. L. 2011: (l)(ee.5) added, (HB 11-1043), ch. 266, p. 1215, 
§ 29, effective July 1; (l)(nnn) added, (SB 11-192), ch. 230, p. 987, § 13, effective July 1. 
L. 2012: (l)(yy) amended, (HB 12-1059), ch. 271, p. 1437, § 18, effective July 1; (l)(nnn) 
amended, (HB 12-1311), ch. 281, p. 1627, § 69, effective July 1. 

Editor's note: Section 26 of chapter 271, Session Laws of Colorado 2012, provides that the act 
amending subsection (l)(yy) appUes to acts committed on or after July 1, 2012. 

25-1-1203. Electronic storage of medical records. Health plans, health care clearing- 
houses, and health care providers shall develop policies, procedures, and systems to comply 
with federal regulations promulgated by the federal department of health and human 
services related to electronic storage and maintenance of medical record information 
pursuant to federal law. 

Source: L. 2001: Entire part added, p. 833, § 5, effective August 8. 



25- 1 - 1 204 Health Title 25 - page 68 

25-1-1204. On-line exchange of advanced directives forms permitted. A public or 
private entity, including a nonprofit organization, that facilitates the exchange of health 
information among emergency medical service providers, doctors, hospitals, nursing 
homes, pharmacies, home health agencies, health plans, and local health information 
agencies through the use of health information technology may facilitate the voluntary, 
secure, and confidential exchange of forms containing advanced directives regarding a 
person's acceptance or rejection of life-sustaining medical or surgical treatment. 

Source: L. 2010: Entire section added, (HB 10-1050), ch. 80, p. 271, § 1, effective 
August 11. L. 2012: Entire section amended, (HB 12-1059), ch. 271, p. 1437, § 19, 
effective July 1. 

Editor's note: Section 26 of chapter 271, Session Laws of Colorado 2012, provides that the act 
amending this section applies to acts committed on or after July 1, 2012. 

PART 13 
CLIMATE CHANGE MARKETS GRANT PROGRAM 

25-1-1301. Short title. This part 13 shall be kjiown and may be cited as the "Colorado 
Climate Change Markets Act". 

Source: L. 2006: Entire part added, p. 1743, § 4, effective June 6. 

25-1-1302. Legislative declaration. (1) The general assembly hereby finds and 
declares that: 

(a) As the United States and other countries take action to address issues related to 
climate change, Colorado faces important policy choices. 

(b) Emerging technologies and markets related to climate change promise significant 
economic opportunities for the state, particularly for agriculture and rural economies. 

(c) The general assembly enacts the "Colorado Climate Change Markets Act" for the 
purpose of positioning Colorado at the forefront of emerging markets related to climate 
change and helping affected industries and economies benefit from these opportunities. 

Source: L. 2006: Entire part added, p. 1743, § 4, effective June 6. 

25-1-1303. Grants for research - reports to general assembly. (1) The department 
of public health and environment shall administer a program to award grants pursuant to 
this section. 

(2) (a) A grant of fifty thousand dollars shall be awarded to Colorado state university 
to conduct research on the potential for the use of terrestrial carbon sequestration in 
agricultural, rangeland, and forest soils as a technique for mitigating the emissions of 
greenhouse gases in the state. 

(b) A grant of fifty thousand dollars shall be awarded to the Colorado school of mines 
to conduct research on the potential for the use of geologic carbon sequestration as a 
technique for mitigating the emissions of greenhouse gases in the state. 

(c) A grant of thirty-five thousand dollars shall be awarded to the university of 
Colorado to conduct research on the emerging international and domestic markets in 
greenhouse gas emissions and to conduct research on private firms in various economic 
sectors that are reducing emissions of greenhouse gases. 

(3) Each recipient of a grant awarded pursuant to this section shall report the results of 
the research conducted under the grant to the agriculture committees of the senate and the 
house of representatives no later than March 15, 2007. 

Source: L. 2006: Entire part added, p. 1743, § 4, effective June 6. 



Title 25 - page 69 



Powers and Duties of the Department 
of Public Health and Environment 

PART 14 



25-1-1403 



HEALTH INFORMATION TECHNOLOGY 
25-1-1401 to 25-1-1403. (Repealed) 

Editor's note: (1) This part 14 was added in 2007 and was not amended prior to its repeal in 
2012. For the text of this part 14 prior to 2012, consult the 2011 Colorado Revised Statutes and the 
Colorado statutory research explanatory note beginning on page vii in the front of this volume. 

(2) Section 25-1-1403 provided for the repeal of this part 14, effective July 1, 2012. (See L. 2007, 
p. 1182.) 

ARTICLE 1.5 

Powers and Duties of the Department 
of Public Health and Environment 

Editor's note: This article was added with relocations in 2003. Former C.R.S. section numbers are 
shown in editor's notes following those sections that were relocated. 



PART 1 

GENERAL POWERS AND DUTIES 

25-1.5-101. Powers and duties of depart- 
ment - laboratory cash fund. 

25-1.5-102. Epidemic and communicable 
diseases - powers and duties 
of department. 

25-1.5-103. Health facilities - powers and 
duties of department - limita- 
tions on rules promulgated 
by department. 

25-1.5-104. Regulation of standards relat- 
ing to food - powers and du- 
ties of department. 

25-1.5-105. Detection of diseases - powers 
and duties of department. 

25-1.5-106. Medical marijuana program - 
powers and duties of state 
health agency - rules - medi- 
cal review board - medical 
marijuana program cash fund 
- created - repeal. 

25-1.5-107. Pandemic influenza - purchase 
of antiviral therapy - defini- 
tions. 

25-1.5-108. Regulation of dialysis treat- 
ment clinics - training for he- 
modialysis technicians - state 
board of health rules - defi- 
nitions - repeal. 

25-1.5-109. Food allergies and anaphylaxis 
form for schools - powers 
and duties of department. 



PART 2 

POWERS AND DUTIES OF THE 

DEPARTMENT WITH RESPECT TO 

WATER 

25-1.5-201. Definitions. 

25-1.5-202. Water - minimum general san- 
itary standards. 

25-1.5-203. Water - powers and duties of 
department. 

25-1.5-204. Inspection for violations of 
minimum general sanitary 
standards relating to quality 
of drinking water. 

25-1.5-205. Advice to other entities. 

25-1.5-206. Applicability. 

25-1.5-207. Damages and injunctive relief 
to prevent or abate release of 
contaminants in water. 

25- 1 .5-208. Grant program for drinking wa- 
ter and water treatment sys- 
tems - small communities 
water and wastewater grant 
fund - rules. 

25-1.5-209. Drinking water fee - drinking 
water cash fund. 

PART 3 

ADMINISTRATION OF MEDICATIONS 

25-1.5-301. Definitions. 

25-1.5-302. Administration of medications 
- powers and duties of de- 
partment - criminal history 
record checks. 

25-1.5-303. Medication reminder boxes or 
systems - medication cash 
fund. 

25- 1 .5-304. Repeal of part. (Repealed) 



25-1.5-101 Health Title 25 - page 70 

PART 1 
GENERAL POWERS AND DUTIES 

25-1.5-101. Powers and duties of department - laboratory cash fund. (1) The 

department has, in addition to all other powers and duties imposed upon it by law, the 
powers and duties provided in this section as follows: 

(a) To close theaters, schools, and other public places, and to forbid gatherings of 
people when necessary to protect the public health; 

(b) (I) To establish and enforce minimum general sanitary standards as to the quality 
of wastes discharged upon land and the quality of fertilizer derived from excreta of human 
beings or from the sludge of sewage disposal plants. 

(II) The phrase "minimum general sanitary standards" as used in this section means the 
minimum standards reasonably consistent with assuring adequate protection of the public 
health. The word "standards" as used in this section means standards reasonably designed 
to promote and protect the public health. 

(c) (I) To collect, compile, and tabulate reports of marriages, dissolution of marriages, 
declaration of invalidity of marriages, births, deaths, and morbidity and to require any 
person having information with regard to the same to make such reports and submit such 
information as the board shall by rule or regulation provide. 

(II) For the purposes of this paragraph (c), the board is authorized to require reporting 
of morbidity and mortality in accordance with the provisions of section 25-1-122. 

(d) To regulate the disposal, transportation, interment, and disinterment of the dead; 

(e) (I) To establish, maintain, and approve chemical, bacteriological, and biological 
laboratories, and to conduct such laboratory investigations and examinations as it may deem 
necessary or proper for the protection of the public health. 

(II) The department shall transmit all fees received by the department in connection 
with the laboratories established pursuant to this paragraph (e), with the exception of fees 
received pursuant to part 10 of article 4 of this title that are credited to the newborn 
screening and genetic counseling cash funds created in section 25-4-1006 (1), to the state 
treasurer, who shall deposit them in the laboratory cash fund, which is hereby created in the 
state treasury. The state treasurer shall credit all interest earned from the revenues in the 
fund to the fund. At the end of each fiscal year, the unencumbered balance of the fund 
remains in the fund. The revenues in the fund are subject to annual appropriation by the 
general assembly to the department to carry out its duties under this paragraph (e). 

(f) To make, approve, and establish standards for diagnostic tests by chemical, bacte- 
riological, and biological laboratories, and to require such laboratories to conform thereto; 
and to prepare, distribute, and require the completion of forms or certificates with respect 
thereto; 

(g) To purchase, and to distribute to licensed physicians and veterinarians, with or 
without charge, as the board may determine upon considerations of emergency or need, 
such vaccines, serums, toxoids, and other approved biological or therapeutic products as 
may be necessary for the protection of the public health; 

(h) To establish and enforce sanitary standards for the operation and maintenance of 
orphanages, day care nurseries, foster homes, family care homes, summer camps for 
children, lodging houses, guest child care facihties as defined in section 26-6-102 (5), 
C.R.S., public services short-term child care facihties as defined in section 26-6-102 (6.7), 
C.R.S., hotels, public conveyances and stations, schools, factories, workshops, industrial 
and labor camps, recreational resorts and camps, swimming pools, public baths, mobile 
home parks, and other buildings, centers, and places used for public gatherings; 

(i) (I) To establish sanitary standards and make sanitary, sewerage, and health inspec- 
tions and examinations for charitable, penal, and other public institutions, and, with respect 
to the state institutions under the department of human services specified in section 
27-90-104, C.R.S., or under the department of corrections specified in section 17-1-104.3 
(1) (b), C.R.S., such inspections and examinations shall be made at least once each year. 
Reports on such inspections of institutions under control of the department of human 



Title 25 - page 71 Powers and Duties of the Department 25-1.5-101 

of Public Health and Environment 

services or the department of corrections shall be made to the executive director of the 
appropriate department for appropriate action, if any. 

(II) Notwithstanding the provisions of subparagraph (I) of this paragraph (i), the 
standards adopted pursuant to subparagraph (I) of this paragraph (i) with regard to space 
requirements, furnishing requirements, required special use areas or special management 
housing, and environmental condition requirements, including but not limited to standards 
pertaining to light, ventilation, temperature, and noise level, shall not apply to any penal 
institution operated by or under contract with a county or municipality if the penal 
institution begins operations on or after August 30, 1999, and if the governing body of the 
jurisdiction operating the penal institution has adopted standards pertaining to such issues 
for the penal institution pursuant to section 30-11-104 (1), C.R.S., or section 31-15-711.5, 
C.R.S., whichever is applicable. 

(j) (I) To disseminate public health information; 

(II) To provide poison control services, for the fiscal year beginning July 1, 2002, and 
fiscal years thereafter, on a statewide basis and to provide for the dissemination of 
information concerning the care and treatment of individuals exposed to poisonous sub- 
stances pursuant to article 32 of this title; 

(k) To establish and enforce standards for exposure to toxic materials in the gaseous, 
liquid, or solid phase that may be deemed necessary for the protection of public health; 

(I) To establish and enforce standards for exposure to environmental conditions, 
including radiation, that may be deemed necessary for the protection of the public health; 

(m) (I) To accept on behalf of and in the name of the state, gifts, donations, and grants 
for any purpose connected with the work and programs of the department. 

(II) Any such property so given shall be held by the state treasurer, but the department 
shall have the power to direct the disposition of any property so given for any purpose 
consistent with the terms and conditions under which such gift was created. 

(n) To carry out the policies of the state as set forth in part 1 of article 6 of this title with 
respect to family planning; 

(o) To carry out the policies of this state relating to the "Colorado Health Care 
Coverage Act" as set forth in parts 1 and 4 of article 16 of title 10, C.R.S.; 

(p) To compile and maintain current information necessary to enable the department to 
answer any inquiry concerning the proper action to take to counteract, eliminate, or 
minimize the public health hazards of a hazardous substance incident involving any specific 
kind of hazardous substance. To make such information available and to facilitate the 
reporting of hazardous substance incidents, the department shall establish, maintain, and 
publicize an environmental emergency telephone service that shall be available to the public 
twenty-four hours each day. With respect to the powers and duties specified in this 
paragraph (p), the department shall have no rule-making authority and shall avail itself of 
all available private resources. As used in this paragraph (p), the terms "hazardous 
substance" and "hazardous substance incident" shall have the meanings ascribed to them 
in section 29-22-101, C.R.S. The department shall coordinate its activities pursuant to this 
section with the Colorado state patrol. 

(q) (I) To establish and maintain a statewide cancer registry providing for compilation 
and analysis of appropriate information regarding incidence, diagnosis, treatment, and end 
results and any other data designed to provide more effective cancer control for the citizens 
of Colorado. 

(II) For the purposes of this paragraph (q), the board is authorized to require reports 
relating to cancer in accordance with the provisions of section 25-1-122 and to have access 
to medical records relating to cancer in accordance with the provisions of section 25-1-122. 

(r) To operate and maintain a program for children with disabilities to provide and 
expedite provision of health care services to children who have congenital birth defects or 
who are the victims of bums or trauma or children who have acquired disabilities; 

(s) To annually enter into an agreement with a qualified person to perform necessary 
hazardous substance incident response actions when such actions are beyond the ability of 
the local and state response capabilities. Such response actions may include, but are not 
limited to, containment, clean-up, and disposal of a hazardous substance. Nothing in this 



25-1.5-101 Health Title 25 - page 72 

article shall prevent the attorney general's office from pursuing cost recovery against 
responsible persons. 

(t) To operate special health programs for migrant and seasonal farm workers and their 
dependent family members and to accept and employ federal and other moneys appropri- 
ated to implement such programs; 

(u) To carry out the duties prescribed in article 11.5 of title 16, C.R.S., relating to 
substance abuse in the criminal justice system; 

(v) To establish and maintain a statewide gulf war syndrome registry pursuant to part 
19 of article 4 of this title providing for compilation and analysis of information regarding 
incidence, diagnosis, treatment, and treatment outcomes of veterans or family members of 
veterans suffering from gulf war syndrome; 

(w) (I) To act as the coordinator for suicide prevention programs throughout the state. 

(II) The department is authorized to accept gifts, grants, and donations to assist it in 
performing its duties as the coordinator for suicide prevention programs. All such gifts, 
grants, and donations shall be transmitted to the state treasurer who shall credit the same to 
the suicide prevention coordination cash fund, which fund is hereby created. Any moneys 
remaining in the suicide prevention coordination cash fund at the end of any fiscal year shall 
remain in the fund and shall not be transferred or credited to the general fund. The general 
assembly shall make appropriations from the suicide prevention coordination cash fund for 
expenditures incurred by the department in the performance of its duties under this 
paragraph (w). 

(III) (A) As part of its duties as coordinator for suicide prevention programs, on or 
before each November 1 , the department shall submit to the chairs of the senate health and 
human services committee and the house of representatives health and environment 
committee, or their successor committees, and to the members of the joint budget com- 
mittee a report listing all suicide prevention programs in the state and describing the 
effectiveness of the department acting as the coordinator for suicide prevention programs. 
For the report submitted in 2013 and each year thereafter, the department shall include any 
findings and recommendations it has to improve suicide prevention in the state. 

(B) (Deleted by amendment, L. 2012.) 

(IV) In its role as coordinator for suicide prevention programs, the department may 
collaborate with each facility licensed or certified pursuant to section 25-1.5-103 in order 
to coordinate suicide prevention services. When a facility treats a person who has attempted 
suicide or exhibits a suicidal gesture, the facility may provide oral and written information 
or educational materials to the person or, in the case of a minor, to parents, relatives, or other 
responsible persons to whom the minor will be released, prior to the person's release, 
regarding warning signs of depression, risk factors of suicide, methods of preventing 
suicide, available suicide prevention resources, and any other information concerning 
suicide awareness and prevention. The department may work with facilities to determine 
whether and where gaps exist in suicide prevention programs and services, including gaps 
that may be present in: 

(A) The information and materials being used and distributed in facilities throughout 
the state; 

(B) Resources available to persons who attempt suicide or exhibit a suicidal gesture 
and, when the person is a minor, to parents, relatives, and other responsible persons to 
whom a minor is released; and 

(C) The process for referring persons who attempt suicide or exhibit a suicidal gesture 
to suicide prevention services and programs or other appropriate health care providers for 
treatment. 

(x) To implement the state dental loan repayment program created in article 23 of this 
title; 

(y) To coordinate with the United States secretary of the interior and the United States 
secretary of agriculture to develop resource management plans consistent with this article 
for federal lands pursuant to 16 U.S.C. sec. 530, 16 U.S.C. sec. 1604, and 43 U.S.C. sec. 
1712; 

(z) To perform the duties specified in part 6 of article 10 of title 30, C.R.S., relating to 
the Colorado coroners standards and training board; 



Title 25 - page 73 



Powers and Duties of the Department 
of Public Health and Environment 



25-1.5-102 



(aa) To determine if there is a shortage of drugs critical to the public safety of the 
people of Colorado and declare an emergency for the purpose of preventing the practice of 
unfair drug pricing as prohibited by section 6-1-714, C.R.S.; 

(bb) To include on its public web site home page a link to forms containing advanced 
directives regarding a person's acceptance or rejection of life-sustaining medical or surgical 
treatment, which forms are available to be downloaded electronically. 

Source: L. 2003: Entire article added with relocations, p. 676, § 2, effective July 1; 
(l)(y) added, p. 1035, § 7, effective April 17; (l)(z) added, p. 1830, § 2, effective August 
6. L. 2005: (l)(aa) added, p. 372, § 1 , effective April 22. L. 2007: (l)(h) amended, p. 866, 
§ 4, effective May 14. L. 2010: (l)(i)(I) amended, (SB 10-175), ch. 188, p. 798, § 58, 
effective April 29; (l)(bb) added, (HB 10-1050), ch. 80, p. 271, § 2, effective August 11. 
L. 2011: (l)(e) amended, (SB 11-161), ch. 12, p. 34, § 1, effective March 9. L. 2012: 
(l)(w)(III) amended and (l)(w)(IV) added, (HB 12-1140), ch. 173, p. 619, § 1, effective 
May 11. 

Editor's note: This section is similar to former § 25-1-107 (l)(c), (l)(e), (l)(f), (l)(g), (l)(h), 
(l)(i), (1)0), (l)(m), (l)(n), (l)(q), (l)(s), (l)(t), (l)(u), (l)(v), (l)(w), (l)(y), (l)(z), (l)(aa), (l)(bb), 
(l)(cc), (l)(fO, (l)(hh), (l)(ii), and (l)(kk) as they existed prior to 2003. 

Cross references: For the legislative declaration contained in the 2003 act enacting (l)(y), see 
section 1 of chapter 145, Session Laws of Colorado 2003. 

ANNOTATION 



Law reviews. For article, "Highlights of the 
1955 Colorado Legislative Session — Water", 
see 28 Rocky Mt. L. Rev. 58 (1955). For note, 
"Water Pollution Control in Colorado", see 36 
U. Colo. L. Rev. 413 (1964). For note, "Rural 
Poverty and the Law in Southern Colorado", see 
47 Den. L.J. 82 (1970). For article, "A Critical 
Evaluation of the Federal Role in Nursing Home 
Quality Enforcement", see 51 U. Colo. L. Rev. 
607 (1980). For article, "Local Governments 
and the Environment: Part I, CERCLA", see 17 
Colo. Law. 1997 (1988). For article, "Local 
Governments and the Environment: Part II, 
RCRA", see 17 Colo. Law. 2159 (1988). For 
article, "The Legal Risks of AIDS: Moving 
Beyond Discrimination", see 18 Colo. Law. 606 
(1989). 

Annotator's note. Since § 25-1.5-101 is 
similar to § 25-1-107 as it existed prior to its 



2003 repeal and relocation to this article 1.5, a 
relevant case construing that provision has been 
included in the annotations to this section. 

Constitutionality of subsection (l)(m). Sub- 
section (l)(m) does not unconstitutionally dele- 
gate any power or duty to the department of 
health, nor does it abdicate the legislative pre- 
rogative of making or defining a law. People ex 
rel. Dunbar v. Giordano, 173 Colo. 567, 481 
P2d415 (1971). 

The scope of authority and guidelines to be 
followed by the department of health in adopt- 
ing sanitary standards are to be those which are 
reasonably designed to promote and protect the 
public health. People ex rel. Dunbar v. Gior- 
dano, 173 Colo. 567, 481 P2d 415 (1971). 



25-1.5-102. Epidemic and communicable diseases - powers and duties of depart- 
ment. ( 1 ) The department has, in addition to all other powers and duties imposed upon it 
by law, the powers and duties provided in this section as follows: 

(a) (I) To investigate and control the causes of epidemic and communicable diseases 
affecting the public health. 

(II) For the purposes of this paragraph (a), the board shall determine, by rule and 
regulation, those epidemic and communicable diseases and conditions that are dangerous to 
the public health. The board is authorized to require reports relating to such designated 
diseases in accordance with the provisions of section 25-1-122 and to have access to 
medical records relating to such designated diseases in accordance with the provisions of 
section 25-1-122. 

(III) For the purposes of this paragraph (a), "epidemic diseases" means cases of an 
illness or condition, communicable or noncommunicable, in excess of normal expectancy, 
compared to the usual frequency of the illness or condition in the same area, among the 



25- 1 .5- 1 02 Health Title 25 - page 74 

specified population, at the same season of the year. A single case of a disease long absent 
from a population may require immediate investigation. 

(IV) For the purposes of this paragraph (a), "communicable diseases" means an illness 
due to a specific infectious agent or its toxic products that arises through transmission of 
that agent or its products from an infected person, animal, or reservoir to a susceptible host, 
either directly or indirectly through an intermediate plant or animal host, vector, or the 
inanimate environment. 

(b) (I) To investigate and monitor the spread of disease that is considered part of an 
emergency epidemic as defined in section 24-32-2103 (1.7), C.R.S., to determine the extent 
of environmental contamination resulting from the emergency epidemic, and to rapidly 
provide epidemiological and environmental information to the governor's expert emer- 
gency epidemic response committee, created in section 24-32-2104 (8), C.R.S. 

(II) Except as otherwise directed by executive order of the governor, the department 
shall exercise its powers and duties to control epidemic and communicable diseases and 
protect the public health as set out in this section. 

(III) The department may accept and expend federal funds, gifts, grants, and donations 
for the purposes of an emergency epidemic or preparation for an emergency epidemic. 

(IV) When a public safety worker, emergency medical service provider, peace officer, 
or staff member of a detention facility has been exposed to blood or other bodily fluid which 
there is a reason to believe may be infectious with hepatitis C, the state department and 
county, district, and municipal public health agencies within their respective jurisdictions 
shall assist in evaluation and treatment of any involved persons by: 

(A) Accessing information on the incident and any persons involved to determine 
whether a potential exposure to hepatitis C occurred; 

(B) Examining and testing such involved persons to determine hepatitis C infection 
when the fact of an exposure has been established by the state department or county, district, 
or municipal public health agency; 

(C) Communicating relevant information and laboratory test results on the involved 
persons to such persons' attending physicians or directly to the involved persons if the 
confidentiality of such information and test results is acknowledged by the recipients and 
adequately protected, as determined by the state department or county, district, or municipal 
public health agency; and 

(D) Providing counseling to the involved persons on the potential health risks resulting 
from exposure and the available methods of treatment. 

(V) The employer of an exposed person shall ensure that relevant information and 
laboratory test results on the involved person are kept confidential. Such information and 
laboratory results are considered medical information and protected from unauthorized 
disclosure. 

(VI) For purposes of this paragraph (b), "public safety worker" includes, but is not 
limited to, law enforcement officers, peace officers, and firefighters. 

(c) To establish, maintain, and enforce isolation and quarantine, and, in pursuance 
thereof and for this purpose only, to exercise such physical control over property and the 
persons of the people within this state as the department may find necessary for the 
protection of the public health; 

(d) To abate nuisances when necessary for the purpose of eliminating sources of 
epidemic and communicable diseases affecting the public health. 

(2) Notwithstanding any other provision of law to the contrary, the department shall 
administer the provisions of this section regardless of an individual's race, religion, gender, 
ethnicity, national origin, or immigration status. 

Source: L. 2003: Entire article added with relocations, p. 680, § 2, effective July 1; 
IP(l)(b)(IV) amended, p. 1617, § 23, effective August 6. L. 2006, 1st Ex. Sess.: (2) added, 
p. 25, § 2, effective July 31. L. 2010: IP(l)(b)(IV), (l)(b)(IV)(B), and (l)(b)(IV)(C) 
amended, (HE 10-1422), ch. 419, p. 2091, § 86, effective August II. 

Editor's note: (1) This section is similar to former § 25-1-107 (l)(a), (l)(a.5), (l)(b), and (l)(d) 
as they existed prior to 2003. 



Title 25 - page 75 Powers and Duties of the Department 25-1 .5-103 

of Public Health and Environment 

(2) Amendments to subsection (l)(b)(IV) by House Bill 03-1266 and Senate Bill 03-002 were 
harmonized. 

ANNOTATION 

Law reviews. For article, "2006 Immigration 
Legislation in Colorado", see 35 Colo. Law. 79 
(October 2006). 

25-1.5-103. Health facilities - powers and duties of department - limitations on 
rules promulgated by department. (1) The department has, in addition to all other 
powers and duties imposed upon it by law, the powers and duties provided in this section 
as follows: 

(a) (I) (A) To annually license and to establish and enforce standards for the operation 
of general hospitals, hospital units as defined in section 25-3-101 (2), psychiatric hospitals, 
community clinics, rehabilitation hospitals, convalescent centers, community mental health 
centers, acute treatment units, facilities for persons with developmental disabilities, nursing 
care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambula- 
tory surgical centers, birthing centers, home care agencies, and other facilities of a like 
nature, except those wholly owned and operated by any governmental unit or agency. 

(B) In establishing and enforcing such standards and in addition to the required 
announced inspections, the department shall, within available appropriations, make addi- 
tional inspections without prior notice to the health facility, subject to sub- subparagraph (C) 
of this subparagraph (I). Such inspections shall be made only during the hours of 7 a.m. to 
7 p.m. 

(C) The department shall extend the survey cycle or conduct a tiered inspection or 
survey of a health facility licensed for at least three years and against which no enforcement 
activity has been taken, no patterns of deficient practices exist, as documented in the 
inspection and survey reports issued by the department, and no substantiated complaint 
resulting in the discovery of significant deficiencies that may negatively affect the life, 
health, or safety of consumers of the health facility has been received within the three years 
prior to the date of the inspection. The department may expand the scope of the inspection 
or survey to an extended or full survey if the department finds deficient practice during the 
tiered inspection or survey. The department, by rule, shall establish a schedule for an 
extended survey cycle or a tiered inspection or survey system designed, at a minimum, to: 
Reduce the time needed for and costs of licensure inspections for both the department and 
the licensed health facility; reduce the number, frequency, and duration of on-site inspec- 
tions; reduce the scope of data and information that health facilities are required to submit 
or provide to the department in connection with the licensure inspection; reduce the amount 
and scope of duplicative data, reports, and information required to complete the licensure 
inspection; and be based on a sample of the facility size. Nothing in this sub-subparagraph 
(C) limits the ability of the department to conduct a periodic inspection or survey that is 
required to meet its obligations as a state survey agency on behalf of the centers for 
medicare and medicaid services or the department of health care policy and financing to 
assure that the health facility meets the requirements for participation in the medicare and 
medicaid programs. 

(D) In connection with the renewal of licenses issued pursuant to this subparagraph (I), 
the department shall institute a performance incentive system pursuant to section 25-3-105 
(1) (a) (I) (C). 

(E) The department shall not cite as a deficiency in a report resulting from a survey or 
inspection of a licensed health facility any deficiency from an isolated event identified by 
the department that can be effectively remedied during the survey or inspection of the health 
facility, unless the deficiency caused harm or a potential for harm, created a life- or 
limb-threatening emergency, or was due to abuse or neglect. 

(F) Sections 24-4-104, C.R.S., and 25-3-102 govern the issuance, suspension, renewal, 
revocation, annulment, or modification of licenses. All licenses issued by the department 
must contain the date of issue and cover a twelve-month period. Nothing contained in this 



25-1.5-103 Health Title 25 - page 76 

paragraph (a) prevents the department from adopting and enforcing, with respect to projects 
for which federal assistance has been obtained or is requested, higher standards as may be 
required by applicable federal laws or regulations of federal agencies responsible for the 
administration of applicable federal laws. 

(II) To establish and enforce standards for the operation and maintenance of the health 
facilities named in subparagraph (I) of this paragraph (a), wholly owned and operated by the 
state or any of its political subdivisions, and no such facility shall be operated or maintained 
without an annual certificate of compliance; 

(b) To suspend, revoke, or refuse to renew any license issued to a health facility 
pursuant to subparagraph (I) or (II) of paragraph (a) of this subsection (1) if such health 
facility has committed abuse of health insurance pursuant to section 18-13-119, C.R.S., or 
if such health facility has advertised through newspapers, magazines, circulars, direct mail, 
directories, radio, television, or otherwise that it will perform any act prohibited by section 
18-13-119 (3), C.R.S., unless the health facility is exempted from section 18-13-119 (5), 
C.R.S.; 

(c) (I) To establish and enforce standards for licensure of community mental health 
centers and acute treatment units. 

(II) The department of public health and environment has primary responsibility for the 
licensure of community mental health centers and acute treatments units. The department 
of human services has primary responsibility for program approval at these facilities. In 
performing their respective responsibilities pursuant to this subparagraph (II), both depart- 
ments shall take into account changes in health care policy and practice incorporating the 
concept and practice of integration of services and the development of a system that 
commingles and integrates health care services. 

(2) For purposes of this section, unless the context otherwise requires: 

(a) "Acute treatment unit" means a facility or a distinct part of a facility for short-term 
psychiatric care, which may include substance abuse treatment, and which provides a total, 
twenty-four-hour therapeutically planned and professionally staffed environment for per- 
sons who do not require inpatient hospitalization but need more intense and individual 
services than are available on an outpatient basis, such as crisis management and stabili- 
zation services. 

(a.5) "Community clinic" has the same meaning as set forth in section 25-3-101 and 
does not include: 

(I) A federally qualified health center, as defined in section 1861 (aa) (4) of the federal 
"Social Security Act", 42 U.S.C. sec. 1395x (aa) (4); 

(II) A rural health clinic, as defined in section 1861 (aa) (2) of the federal "Social 
Security Act", 42 U.S.C. sec. 1395x (aa) (2). 

(b) "Community mental health center" means either a physical plant or a group of 
services under unified administration and including at least the following: Inpatient ser- 
vices; outpatient services; day hospitalization; emergency services; and consultation and 
educational services, which services are provided principally for persons with mental illness 
residing in a particular community in or near which the facility is situated. 

(b.5) "Enforcement activity" means the imposition of remedies such as civil money 
penalties; appointment of a receiver or temporary manager; conditional licensure; suspen- 
sion or revocation of a license; a directed plan of correction; intermediate restrictions or 
conditions, including retaining a consultant, department monitoring, or providing additional 
training to employees, owners, or operators; or any other remedy provided by state or 
federal law or as authorized by federal survey, certification, and enforcement regulations 
and agreements for violations of federal or state law. 

(c) "Facility for persons with developmental disabilities" means a facility specially 
designed for the active treatment and habilitation of persons with developmental disabilities 
or a community residential home, as defined in section 27-10.5-102 (4), C.R.S., which is 
licensed and certified pursuant to section 27-10.5-109, C.R.S. 

(d) "Hospice care" means an entity that administers services to a terminally ill person 
utilizing palliative care or treatment. 

(3) (a) In the exercise of its powers pursuant to this section, the department shall not 
promulgate any rule, regulation, or standard relating to nursing personnel for rural nursing 



Title 25 - page 77 Powers and Duties of the Department 25-1.5-103 

of Public Health and Environment 

care facilities, rural intermediate care facilities, and other rural facilities of a like nature 
more stringent than the applicable federal standards and regulations. 

(b) For purposes of this subsection (3), "rural" means: 

(I) A county of less than fifteen thousand population; or 

(II) A municipality of less than fifteen thousand population which is located ten miles 
or more from a municipality of over fifteen thousand population; or 

(III) The unincorporated part of a county ten miles or more from a municipality of 
fifteen thousand population or more. 

(c) A nursing care facility which is not rural as defined in paragraph (b) of this 
subsection (3) shall meet the licensing requirements of the department for nursing care 
facilities. However, if a registered nurse hired pursuant to department regulations is 
temporarily unavailable, a nursing care facility may use a licensed practical nurse in place 
of a registered nurse if such licensed practical nurse is a current employee of the nursing 
care facility. 

(3.5) (a) (I) The department of public health and environment may establish life safety 
code and physical plant requirements for an occupancy that is contiguous with an acute 
treatment unit if the occupancy is operated by the acute treatment unit licensee and the 
services provided by the occupancy are outpatient services certified in accordance with 
article 65 of title 27, C.R.S., to determine appropriate placement or detoxification services 
licensed by the department of human services. The services provided by the occupancy shall 
benefit acute treatment unit clients, although the occupancy may also provide such services 
to other populations. It shall be at the discretion of the acute treatment unit licensee to either 
construct the necessary fire safety separations between the occupancy and the acute 
treatment unit or to assume fiscal and administrative responsibility for assuring that the 
occupancy meets the life safety code requirements as specified and verified by the 
department of public health and environment. 

(II) The state board of health may promulgate rules authorizing the department of 
public health and environment to assess a penalty of up to one hundred dollars per day if 
the department finds that an occupancy does not comply with life safety code requirements. 
The department shall only assess the penalty after the acute treatment unit licensee has had 
an opportunity to correct the noncompliance. 

(III) Nothing in this subsection (3.5) shall be construed to extend the life safety code 
authority of the department of public health and environment to an occupancy that is not 
subject to licensure by the department and that has the appropriate fire safety separations 
between the occupancy and the acute treatment unit. 

(b) A licensee that is subject to life safety code oversight of one or more occupancies 
pursuant to paragraph (a) of this subsection (3.5) shall pay a fee or fees in accordance with 
rules promulgated by the state board of health. 

(c) Any moneys collected pursuant to this subsection (3.5) shall be transmitted to the 
state treasurer, who shall credit the same to the health facilities general licensure cash fund 
created in section 25-3-103.1. 

(4) In the exercise of its powers, the department shall not promulgate any rule, 
regulation, or standard that limits or interferes with the ability of an individual to enter into 
a contract with a private pay facility concerning the programs or services provided at the 
private pay facility. For the purposes of this subsection (4), "private pay facility" means a 
skilled nursing facility or intermediate care facility subject to the requirements of section 
25-1-120 or an assisted living residence licensed pursuant to section 25-27-105 that is not 
publicly funded or is not certified to provide services that are reimbursed from state or 
federal assistance funds. 

(5) (a) This subsection (5) applies to construction, including substantial renovation, 
and ongoing compliance with article 33.5 of title 24, C.R.S., of a health care facility 
building or structure on or after July 1, 2013. All health facility buildings and structures 
shall be constructed in conformity with the standards adopted by the director of the division 
of fire prevention and control in the office of preparedness, security, and fire safety within 
the department of public safety. 

(b) Except as provided in paragraph (c) of this subsection (5) but notwithstanding any 
other provision of law to the contrary, the department shall not issue or renew any license 



25-1.5-103 Health Title 25 - page 78 

under this article unless the department has received a certificate of compliance from the 
division of fire prevention and control certifying that the building or structure of the health 
facility is in conformity with the standards adopted by the director of the division of fire 
prevention and control. 

(c) The department has no authority to establish or enforce standards relating to 
building or fire codes. All functions, personnel, and property of the department as of June 
30, 2013, that are principally directed to the administration, inspection, and enforcement of 
any building or fire codes or standards shall be transferred to the health facility construction 
and inspection section of the division of fire prevention and control pursuant to section 
24-33.5-1201 (5), C.R.S. 

(d) Notwithstanding any provision of law to the contrary, all health facilities seeking 
certification pursuant to the federal insurance or assistance provided by title XIX of the 
federal "Social Security Act", as amended and commonly known as "medicaid", or the 
federal insurance or assistance provided by title XVIII of the federal "Social Security Act", 
as amended and commonly known as "medicare", or any successor code adopted or 
promulgated by the appropriate federal authorities, shall continue to meet such certification 
requirements. 

(e) Nothing in this subsection (5) divests the department of the authority to perform 
health survey work or prevents the department from accessing related funds. 

Editor's note: Subsection (5) is effective July 1, 2013, only if the revisor of statutes receives 
notification. (See the editor's note following this secfion.) 

Source: L. 2003: Entire article added with relocations, p. 682, § 2, effective July 1. 
L. 2006: (l)(a)(I), (l)(c)(I), (2), and (2)(b) amended, pp. 1389, 1404, §§ 21, 63, effective 
August 7. L. 2008: (3.5) added, p. 1947, § 1, effective June 2; (l)(a)(I) amended, p. 2232, 
§ 1, effective August 5. L. 2010: (3.5)(a)(I) amended, (SB 10-175), ch. 188, p. 798, § 59, 
effective April 29. L. 2011: (2)(a.5) added, (HB 11-1101), ch. 94, p. 277, § 1, effective 
April 8; (2)(a.5) amended, (HB 11-1323), ch. 265, p. 1198, § 1, effective June 2. L. 2012: 
(l)(a)(I), (l)(c), and IP(2)(a.5) amended and (2)(b.5) added, (HB 12-1294), ch. 252, p. 
1251, § 2, effective June 4; (5) added, (HB 12-1268), ch. 234, p. 1024, § 1, effective July 
1, 2013. 

Editor's note: (1) This secfion is similar to former § 25-1-107 (1)(1), (3), and (4) as they existed 
prior to 2003. 

(2) Amendments to subsection (2) in sections 21 and 63 of House Bill 06-1277 were harmonized. 
As a result of the harmonization, subsecfion (2)(a) in section 63 of House Bill 06-1277 was 
renumbered as subsection (2)(b). 

(3) Section 15 of chapter 234, Session Laws of Colorado 2012, provides that subsecfion (5) is 
effecfive July 1, 2013, only if the division of fire prevention and control in the department of public 
safety notifies the revisor of statutes in writing, by June 30, 2013, that the secretary of the United 
States department of health and human services has granted a modification to the agreement entered 
into between said secretary and the state of Colorado pursuant to secfion 1864 of the federal "Social 
Security Act", 42 U.S.C. sec. 1395aa, which modificafion allows said division to fulfill the duties 
under that law associated with the assessment of compliance with the federal fire safety code 
requirements for health facilities. 

Cross references: For the legislafive declaration in the 2012 act amending subsecfions (l)(a)(I) and 
(l)(c) and the introductory portion to subsection (2)(a.5) and adding subsecfion (2)(b.5), see secfion 
1 of chapter 252, Session Laws of Colorado 2012. 

ANNOTATION 

Annotator's note. Since § 25-1.5-103 is department of public health. Adams v. Poudre 

similar to § 25-1-107 as it existed prior to its Valley Hosp. Dist., 173 Colo. 98, 476 P.2d 565 

2003 repeal and relocation to this article 1.5, a (1970). 

relevant case construing that provision has been Thus, subsection (1)(I)(II), "certificate of 

included in the annotafions to this secfion. compliance", is not a license. Adams v. Poudre 

This section is not a licensing statute, but Valley Hosp. Dist., 173 Colo. 98, 476 P2d 565 

rather one specifying the powers of the state (1970). 



Title 25 - page 79 Powers and Duties of the Department 25-1.5-105 

of Public Health and Environment 

25-1.5-104. Regulation of standards relating to food - powers and duties of 
department. (1) The department has, in addition to all other powers and duties imposed 
upon it by law, the powers and duties provided in this section as follows: 

(a) To impound any vegetables and other edible crops and meat and animal products 
intended for and unfit for human consumption, and, upon five days' notice and after 
affording reasonable opportunity for a hearing to the interested parties, to condemn and 
destroy the same if deemed necessary for the protection of the public health; 

(b) (I) To promulgate and enforce rules, regulations, and standards for the grading, 
labeling, classification, and composition of milk, milk products, and dairy products, 
including imitation dairy products; to establish minimum general sanitary standards of 
quality of all milk, milk products, dairy products, and imitation dairy products sold for 
human consumption in this state; to inspect and supervise, in dairy plants or dairy farms and 
in other establishments handling any milk, milk products, dairy products, or imitation dairy 
products, the sanitation of production, processing, and distribution of all milk, milk 
products, dairy products, and imitation dairy products sold for human consumption in this 
state and, to this end, to take samples of milk, milk products, dairy products, and imitation 
dairy products for bacteriological, chemical, and other analyses; and to enforce the 
standards for milk, milk products, dairy products, and imitation dairy products in processing 
plants, dairy farms, and other facilities and establishments handling, transporting, or selling 
such products; to certify persons licensed by the department under the provisions of section 
25-5.5-107 as duly qualified persons for the purpose of collecting raw milk samples for 
official analyses in accordance with minimum qualifications established by the department; 
to issue, for the fees established by law, licenses and temporary permits to operate milk 
plants, dairy plants, receiving stations, dairy farms, and other facilities manufacturing any 
milk, milk products, dairy products, or imitation dairy products for human consumption. 

(II) The phrase "minimum general sanitary standards" as used in this section means the 
minimum standards reasonably consistent with assuring adequate protection of the public 
health. The word "standards" as used in this section means standards reasonably designed 
to promote and protect the public health. 

(c) To promulgate and enforce rules and regulations for the labeling and sale of 
oleomargarine and for the governing of milk- or cream- weighing-and-testing operations; 

(d) To approve all oils used in reading tests of samples of cream and milk; 

(e) To examine and license persons to sample or test milk, cream, or other dairy 
products for the purpose of determining the value of such products or to instruct other 
persons in the sampling and testing of such products and to cancel licenses issued by the 
department on account of incompetency or any violation of the provisions of the dairy laws 
or the rules and regulations promulgated by the board; 

(f) To license manufacturers of oleomargarine; 

(g) To establish and enforce sanitary standards for the operation of slaughtering, 
packing, canning, and rendering establishments and stores, shops, and vehicles wherein 
meat and animal products intended for human consumption may be offered for sale or 
transported, but this shall not be construed to authorize any state officer or employee to 
interfere with regulations or inspections made by anyone acting under the laws of the 
United States. 

Source: L. 2003: Entire article added with relocations, p. 684, § 2, effective July 1. 

Editor's note: This secdon is similar to former § 25-1.5-107 (l)(k), (l)(o), and (l)(p) as they 
existed prior to 2003. 

25-1.5-105. Detection of diseases - powers and duties of department. (1) The 

department has, in addition to all other powers and duties imposed upon it by law, the 
powers and duties provided in this section as follows: 

(a) To establish and operate programs which the department determines are important 
in promoting, protecting, and maintaining the public's health by preventing, delaying, or 
detecting the onset of environmental and chronic diseases; 



25- 1 .5- 1 06 Health Title 25 - page 80 

(b) To develop and maintain a system for detecting and monitoring environmental and 
chronic diseases within the state and to investigate and determine the epidemiology of those 
conditions which contribute to preventable or premature sickness and to death and disabil- 
ity; 

(c) To establish programs of community and professional education relevant to the 
detection, prevention, and control of environmental and chronic diseases. 

(2) For purposes of this section, "chronic disease" means impairment or deviation from 
the normal functioning of the human body which: 

(a) Is permanent; 

(b) Leaves residual disability; 

(c) Is caused by nonreversible pathological alterations; 

(d) Requires special patient education and instruction for rehabilitation; or 

(e) May require a long period of supervision, observation, and care. 

(3) For the purposes of this section, "environmental disease" means an impairment or 
deviation from the normal functioning of the human body which: 

(a) May be either temporary or permanent; 

(b) May leave residual disability; 

(c) May result in birth defects, damage to tissues and organs, and chronic illness; and 

(d) Is caused by exposure to hazardous chemical or radiological materials present in the 
environment. 

(4) For the purposes of this section, the board shall determine, by rule and regulation, 
those environmental and chronic diseases that are dangerous to the public health. The board 
is authorized to require reports relating to such designated diseases in accordance with the 
provisions of section 25-1-122 and to have access to medical records relating to such 
designated diseases in accordance with the provisions of section 25-1-122. 

Source: L. 2003: Entire article added with relocations, p. 685, § 2, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(dd) as it existed prior to 2003. 

25-1.5-106. Medical marijuana program - powers and duties of state health agency 
- rules - medical review board - medical marijuana program cash fund - created - 
repeal. (1) Legislative declaration, (a) The general assembly hereby declares that it is 
necessary to implement rules to ensure that patients suffering from legitimate debilitating 
medical conditions are able to safely gain access to medical marijuana and to ensure that 
these patients: 

(1) Are not subject to criminal prosecution for their use of medical marijuana in 
accordance with section 14 of article XVIII of the state constitution, this section, and the 
rules of the state health agency; and 

(II) Are able to establish an affirmative defense to their use of medical marijuana in 
accordance with section 14 of article XVIII of the state constitution, this section, and the 
rules of the state health agency. 

(b) The general assembly hereby declares that it is necessary to implement rules to 
prevent persons who do not suffer from legitimate debilitating medical conditions from 
using section 14 of article XVIII of the state constitution as a means to sell, acquire, possess, 
produce, use, or transport marijuana in violation of state and federal laws. 

(2) Definitions. In addition to the definitions set forth in section 14 (1) of article XVIII 
of the state constitution, as used in this section, unless the context otherwise requires: 

(a) "Bona fide physician-patient relationship", for purposes of the medical marijuana 
program, means: 

(I) A physician and a patient have a treatment or counseling relationship, in the course 
of which the physician has completed a full assessment of the patient's medical history and 
current medical condition, including an appropriate personal physical examination; 

(II) The physician has consulted with the patient with respect to the patient's debiU- 
tating medical condition before the patient applies for a registry identification card; and 



Title 25 - page 81 Powers and Duties of the Department 25-1 .5-106 

of Public Health and Environment 

(III) The physician is available to or offers to provide follow-up care and treatment to 
the patient, including but not limited to patient examinations, to determine the efficacy of 
the use of medical marijuana as a treatment of the patient's debilitating medical condition. 

(b) "Executive director" means the executive director of the state health agency. 

(c) "In good standing", with respect to a physician's license, means: 

(I) The physician holds a doctor of medicine or doctor of osteopathic medicine degree 
from an accredited medical school; 

(II) The physician holds a valid license to practice medicine in Colorado that does not 
contain a restriction or condition that prohibits the recommendation of medical marijuana 
or for a license issued prior to July 1, 2011, a valid, unrestricted and unconditioned license; 
and 

(III) The physician has a valid and unrestricted United States department of justice 
federal drug enforcement administration controlled substances registration. 

(d) "Medical marijuana program" means the program established by section 14 of 
article XVIII of the state constitution and this section, 

(d.5) "Primary caregiver" means a natural person, other than the patient or the patient's 
physician, who is eighteen years of age or older and has significant responsibility for 
managing the well-being of a patient who has a debilitating medical condition. 

(e) "Registry identification card" means the nontransferable confidential registry iden- 
tification card issued by the state health agency to patients and primary caregivers pursuant 
to this section. 

(f) "State health agency" means the public health-related entity of state government 
designated by the governor by executive order pursuant to section 14 of article XVIII of the 
state constitution. 

(3) Rule-making, (a) The state health agency shall, pursuant to section 14 of article 
XVIII of the state constitution, promulgate rules of administration concerning the imple- 
mentation of the medical marijuana program that specifically govern the following: 

(I) The establishment and maintenance of a confidential registry of patients who have 
applied for and are entitled to receive a registry identification card. The confidential registry 
of patients may be used to determine whether a physician should be referred to the Colorado 
board of medical examiners for a suspected violation of section 14 of article XVIII of the 
state constitution, paragraph (a), (b), or (c) of subsection (5) of this section, or the rules 
promulgated by the state health agency pursuant to this subsection (3). 

(II) The development by the state health agency of an application form and the process 
for making the form available to residents of this state seeking to be listed on the 
confidential registry of patients who are entitled to receive a registry identification card; 

(III) The verification by the state health agency of medical information concerning 
patients who have applied for a registry identification card or for renewal of a registry 
identification card; 

(IV) The development by the state health agency of a form that constitutes "written 
documentation" as defined and used in section 14 of article XVIII of the state constitution, 
which form a physician shall use when making a medical marijuana recommendation for a 
patient; 

(V) The conditions for issuance and renewal, and the form, of the registry identification 
cards issued to patients, including but not limited to standards for ensuring that the state 
health agency issues a registry identification card to a patient only if he or she has a bona 
fide physician-patient relationship with a physician in good standing and licensed to 
practice medicine in the state of Colorado; 

(VI) Communications with law enforcement officials about registry identification cards 
that have been suspended when a patient is no longer diagnosed as having a debilitating 
medical condition; 

(VII) The manner in which the state health agency may consider adding debilitating 
medical conditions to the list of debiUtating medical conditions contained in section 14 of 
article XVIII of the state constitution; and 

(VIII) A waiver process to allow a homebound patient who is on the registry to have 
a primary caregiver transport the patient's medical marijuana from a licensed medical 
marijuana center to the patient. 



25- 1 .5-106 Health Title 25 - page 82 

(b) The state health agency may promulgate rules regarding the following: 

(I) What constitutes "significant responsibility for managing the well-being of a 
patient"; except that the act of supplying medical marijuana or marijuana paraphernalia, by 
itself, is insufficient to constitute "significant responsibility for managing the well-being of 
a patient"; 

(II) The development of a form for a primary caregiver to use in applying to the 
registry, which form shall require, at a minimum, that the applicant provide his or her full 
name, home address, date of birth, and an attestation that the applicant has a significant 
responsibility for managing the well-being of the patient for whom he or she is designated 
as the primary caregiver and that he or she understands and will abide by section 14 of 
article XVIII of the state constitution, this section, and the rules promulgated by the state 
health agency pursuant to this section; 

(III) The development of a form that constitutes "written documentation", as defined 
and used in section 14 of article XVIII of the state constitution, which form a physician shall 
use when making a medical marijuana recommendation for a patient; and 

(IV) The grounds and procedure for a patient to change his or her designated primary 
caregiver. 

(c) Repealed. 

(4) Notwithstanding any other requirements to the contrary, notice issued by the state 
health agency for a rule-making hearing pursuant to section 24-4-103, C.R.S., for rules 
concerning the medical marijuana program shall be sufficient if the state health agency 
provides the notice no later than forty-five days in advance of the rule-making hearing in 
at least one publication in a newspaper of general distribution in the state and posts the 
notice on the state health agency's web site; except that emergency rules pursuant to section 
24-4-103 (6), C.R.S., shall not require advance notice. 

(5) Physicians. A physician who certifies a debilitating medical condition for an 
applicant to the medical marijuana program shall comply with all of the following 
requirements: 

(a) The physician shall have a valid and active license to practice medicine, which 
hcense is in good standing. 

(b) After a physician, who has a bona fide physician-patient relationship with the 
patient applying for the medical marijuana program, determines, for the purposes of making 
a recommendation, that the patient has a debilitating medical condition and that the patient 
may benefit from the use of medical marijuana, the physician shall certify to the state health 
agency that the patient has a debilitating medical condition and that the patient may benefit 
from the use of medical marijuana. If the physician certifies that the patient would benefit 
from the use of medical marijuana based on a chronic or debilitating disease or medical 
condition, the physician shall specify the chronic or debilitating disease or medical 
condition and, if known, the cause or source of the chronic or debilitating disease or medical 
condition. 

(c) The physician shall maintain a record-keeping system for all patients for whom the 
physician has recommended the medical use of marijuana, and, pursuant to an investigation 
initiated pursuant to section 12-36-118, C.R.S., the physician shall produce such medical 
records to the Colorado state board of medical examiners after redacting any patient or 
primary caregiver identifying information. 

(d) A physician shall not: 

(I) Accept, solicit, or offer any form of pecuniary remuneration from or to a primary 
caregiver, distributor, or any other provider of medical marijuana; 

(II) Offer a discount or any other thing of value to a patient who uses or agrees to use 
a particular primary caregiver, distributor, or other provider of medical marijuana to procure 
medical marijuana; 

(III) Examine a patient for purposes of diagnosing a debilitating medical condition at 
a location where medical marijuana is sold or distributed; or 

(IV) Hold an economic interest in an enterprise that provides or distributes medical 
marijuana if the physician certifies the debilitating medical condition of a patient for 
participation in the medical marijuana program. 



Title 25 - page 83 Powers and Duties of the Department 25-1.5-106 

of Public Health and Environment 

(6) Enforcement, (a) If the state health agency has reasonable cause to believe that 
a physician has violated section 14 of article XVIII of the state constitution, paragraph (a), 
(b), or (c) of subsection (5) of this section, or the rules promulgated by the state health 
agency pursuant to subsection (2) of this section, the state health agency may refer the 
matter to the state board of medical examiners created in section 12-36-103, C.R.S., for an 
investigation and determination. 

(b) If the state health agency has reasonable cause to believe that a physician has 
violated paragraph (d) of subsection (5) of this section, the state health agency shall conduct 
a hearing pursuant to section 24-4-104, C.R.S., to determine whether a violation has 
occurred. 

(c) Upon a finding of unprofessional conduct pursuant to section 12-36-117 (1) (mm), 
C.R.S., by the state board of medical examiners or a finding of a violation of paragraph (d) 
of subsection (5) of this section by the state health agency, the state health agency shall 
restrict a physician's authority to recommend the use of medical marijuana, which restric- 
tions may include the revocation or suspension of a physician's privilege to recommend 
medical marijuana. The restriction shall be in addition to any sanction imposed by the state 
board of medical examiners. 

(d) When the state health agency has objective and reasonable grounds to believe and 
finds, upon a full investigation, that a physician has deliberately and willfully violated 
section 14 of article XVIII of the state constitution or this section and that the public health, 
safety, or welfare imperatively requires emergency action, and the state health agency 
incorporates those findings into an order, the state health agency may summarily suspend 
the physician's authority to recommend the use of medical marijuana pending the proceed- 
ings set forth in paragraphs (a) and (b) of this subsection (6). A hearing on the order of 
summary suspension shall be held no later than thirty days after the issuance of the order 
of summary suspension, unless a longer time is agreed to by the parties, and an initial 
decision in accordance with section 24-4-105 (14), C.R.S., shall be rendered no later than 
thirty days after the conclusion of the hearing concerning the order of summary suspension. 

(7) Primary caregivers, (a) A primary caregiver may not delegate to any other 
person his or her authority to provide medical marijuana to a patient nor may a primary 
caregiver engage others to assist in providing medical marijuana to a patient. 

(b) Two or more primary caregivers shall not join together for the purpose of cultivat- 
ing medical marijuana. 

(c) Only a medical marijuana center with an optional premises cultivation license, a 
medical marijuana-infused products manufacturing operation with an optional premises 
cultivation license, or a primary caregiver for his or her patients or a patient for himself or 
herself may cultivate or provide marijuana and only for medical use. 

(d) A primary caregiver shall provide to a law enforcement agency, upon inquiry, the 
registry identification card number of each of his or her patients. The state health agency 
shall maintain a registry of this information and make it available twenty-four hours per day 
and seven days a week to law enforcement for verification purposes. Upon inquiry by a law 
enforcement officer as to an individual's status as a patient or primary caregiver, the state 
health agency shall check the registry. If the individual is not registered as a patient or 
primary caregiver, the state health agency may provide that response to law enforcement. 
If the person is a registered patient or primary caregiver, the state health agency may not 
release information unless consistent with section 14 of article XVIII of the state consti- 
tution. The state health agency may promulgate rules to provide for the efficient adminis- 
tration of this paragraph (d). 

(e) A primary caregiver who cultivates medical marijuana for his or her patients shall 
register the location of his or her cultivation operation with the state medical marijuana 
licensing authority and provide the registration identification number of each patient to the 
state licensing authority. The information provided to the state medical marijuana licensing 
authority pursuant to this paragraph (e) shall not be provided to the public and shall be 
confidential. The state licensing authority shall verify the location of a primary caregiver 
cultivation operation to a local government or law enforcement agency upon receiving an 
address-specific request for verification. The location of the cultivation operation shall 
comply with all applicable local laws, rules, or regulations. 



25- 1 .5- 1 06 Health Title 25 - page 84 

(8) Patient - primary caregiver relationship, (a) A person shall be listed as a 
primary caregiver for no more than five patients on the medical marijuana program registry 
at any given time; except that the state health agency may allow a primary caregiver to serve 
more than five patients in exceptional circumstances. In determining whether exceptional 
circumstances exist, the state health agency may consider the proximity of medical 
marijuana centers to the patient. A primary caregiver shall maintain a list of his or her 
patients including the registry identification card number of each patient at all times. 

(b) A patient shall have only one primary caregiver at any given time. 

(c) A patient who has designated a primary caregiver for himself or herself may not be 
designated as a primary caregiver for another patient. 

(d) A primary caregiver may not charge a patient more than the cost of cultivating or 
purchasing the medical marijuana, but may charge for caregiver services. 

(e) (I) The state health agency shall maintain a secure and confidential registry of 
available primary caregivers for those patients who are unable to secure the services of a 
primary caregiver. 

(II) An existing primary caregiver may indicate at the time of registration whether he 
or she would be willing to handle additional patients and waive confidentiality to allow 
release of his or her contact information to physicians or registered patients only. 

(III) An individual who is not registered but is willing to provide primary caregiving 
services may submit his or her contact information to be placed on the primary caregiver 
registry. 

(IV) A patient-primary caregiver arrangement secured pursuant to this paragraph (e) 
shall be strictly between the patient and the potential primary caregiver. The state health 
agency, by providing the information required by this paragraph (e), shall not endorse or 
vouch for a primary caregiver. 

(V) The state health agency may make an exception, based on a request from a patient, 
to paragraph (a) of this subsection (8) limiting primary caregivers to five patients. If the 
state health agency makes an exception to the limit, the state health agency shall note the 
exception on the primary caregiver's record in the registry. 

(f) At the time a patient applies for inclusion on the confidential registry, the patient 
shall indicate whether the patient intends to cultivate his or her own medical marijuana, both 
cultivate his or her own medical marijuana and obtain it from either a primary caregiver or 
licensed medical marijuana center, or obtain it from either a primary caregiver or a licensed 
medical marijuana center. If the patient elects to use a licensed medical marijuana center, 
the patient shall register the primary center he or she intends to use. 

(9) Registry identification card required - denial - revocation - renewal, (a) To be 
considered in compliance with the provisions of section 14 of article XVIII of the state 
constitution, this section, and the rules of the state health agency, a patient or primary 
caregiver shall have his or her registry identification card in his or her possession at all times 
that he or she is in possession of any form of medical marijuana and produce the same upon 
request of a law enforcement officer to demonstrate that the patient or primary caregiver is 
not in violation of the law; except that, if more than thirty-five days have passed since the 
date the patient or primary caregiver filed his or her medical marijuana program application 
and the state health agency has not yet issued or denied a registry identification card, a copy 
of the patient's or primary caregiver's application along with proof of the date of 
submission shall be in the patient's or primary caregiver's possession at all times that he or 
she is in possession of any form of medical marijuana until the state health agency issues 
or denies the registry identification card. A person who violates section 14 of article XVIII 
of the state constitution, this section, or the rules promulgated by the state health agency 
may be subject to criminal prosecution for violations of section 18-18-406, C.R.S. 

(b) The state health agency may deny a patient's or primary caregiver's application for 
a registry identification card or revoke the card if the state health agency, in accordance with 
article 4 of title 24, C.R.S., determines that the physician who diagnosed the patient's 
debilitating medical condition, the patient, or the primary caregiver violated section 14 of 
article XVIII of the state constitution, this section, or the rules promulgated by the state 
health agency pursuant to this section; except that, when a physician's violation is the basis 
for adverse action, the state health agency may only deny or revoke a patient's application 



Title 25 - page 85 Powers and Duties of the Department 25-1.5-106 

of Public Health and Environment 

or registry identification card when the physician's violation is related to the issuance of a 
medical marijuana recommendation. 

(c) A patient or primary caregiver registry identification card shall be valid for one year 
and shall contain a unique identification number. It shall be the responsibility of the patient 
or primary caregiver to apply to renew his or her registry identification card prior to the date 
on which the card expires. The state health agency shall develop a form for a patient or 
primary caregiver to use in renewing his or her registry identification card. 

(d) If the state health agency grants a patient a waiver to allow a primary caregiver to 
transport the patient's medical marijuana from a medical marijuana center to the patient, the 
state health agency shall designate the waiver on the patient's registry identification card. 

(e) A homebound patient who receives a waiver from the state health agency to allow 
a primary caregiver to transport the patient's medical marijuana to the patient from a 
medical marijuana center shall provide the primary caregiver with the patient's registry 
identification card, which the primary caregiver shall carry when the primary caregiver is 
transporting the medical marijuana. A medical marijuana center may provide the medical 
marijuana to the primary caregiver for transport to the patient if the primary caregiver 
produces the patient's registry identification card. 

(10) Renewal of patient identification card upon criminal conviction. Any patient 
who is convicted of a criminal offense under article 18 of title 18, C.R.S., sentenced or 
ordered by a court to drug or substance abuse treatment, or sentenced to the division of 
youth corrections, shall be subject to immediate renewal of his or her patient registry 
identification card, and the patient shall apply for the renewal based upon a recommendation 
from a physician with whom the patient has a bona fide physician-patient relationship. 

(11) A parent who submits a medical marijuana registry application for his or her child 
shall have his or her signature notarized on the application. 

(12) Use of medical marijuana, (a) The use of medical marijuana is allowed under 
state law to the extent that it is carried out in accordance with the provisions of section 14 
of article XVIII of the state constitution, this section, and the rules of the state health 
agency. 

(b) A patient or primary caregiver shall not: 

(I) Engage in the medical use of marijuana in a way that endangers the health and 
well-being of a person; 

(II) Engage in the medical use of marijuana in plain view of or in a place open to the 
general public; 

(III) Undertake any task while under the influence of medical marijuana, when doing 
so would constitute negligence or professional malpractice; 

(IV) Possess medical marijuana or otherwise engage in the use of medical marijuana in 
or on the grounds of a school or in a school bus; 

(V) Engage in the use of medical marijuana while: 

(A) In a correctional facility or a community corrections facility; 

(B) Subject to a sentence to incarceration; or 

(C) In a vehicle, aircraft, or motorboat; 

(VI) Operate, navigate, or be in actual physical control of any vehicle, aircraft, or 
motorboat while under the influence of medical marijuana; or 

(VII) Use medical marijuana if the person does not have a debilitating medical 
condition as diagnosed by the person's physician in the course of a bona fide physician- 
patient relationship and for which the physician has recommended the use of medical 
marijuana. 

(c) A person shall not establish a business to permit patients to congregate and smoke 
or otherwise consume medical marijuana. 

(13) Limit on cultivation of medical marijuana. Only registered patients, licensed 
primary caregivers, medical marijuana-infused products manufacturing operations with an 
optional premises cultivation license, and licensed medical marijuana centers with optional 
premises cultivation licenses may cultivate medical marijuana. 

(14) Affirmative defense. If a patient or primary caregiver raises an affirmative defense 
as provided in section 14 (4) (b) of article XVIII of the state constitution, the patient's 
physician shall certify the specific amounts in excess of two ounces that are necessary to 



25-1.5-106 Health Title 25 - page 86 

address the patient' s debilitating medical condition and why such amounts are necessary. A 
patient who asserts this affirmative defense shall waive confidentiality privileges related to 
the condition or conditions that were the basis for the recommendation. If a patient, primary 
caregiver, or physician raises an exception to the state criminal laws as provided in section 
14 (2) (b) or (2) (c) of article XVIII of the state constitution, the patient, primary caregiver, 
or physician waives the confidentiality of his or her records related to the condition or 
conditions that were the basis for the recommendation maintained by the state health agency 
for the medical marijuana program. Upon request of a law enforcement agency for such 
records, the state health agency shall only provide records pertaining to the individual 
raising the exception, and shall redact all other patient, primary caregiver, or physician 
identifying information. 

(15) (a) Except as provided in paragraph (b) of this subsection (15), the state health 
agency shall establish a basic fee that shall be paid at the time of service of any subpoena 
upon the state health agency, plus a fee for meals and a fee for mileage at the rate prescribed 
for state officers and employees in section 24-9-104, C.R.S., for each mile actually and 
necessarily traveled in going to and returning from the place named in the subpoena. If the 
person named in the subpoena is required to attend the place named in the subpoena for 
more than one day, there shall be paid, in advance, a sum to be established by the state 
health agency for each day of attendance to cover the expenses of the person named in the 
subpoena. 

(b) The subpoena fee estabhshed pursuant to paragraph (a) of this subsection (15) shall 
not be apphcable to any federal, state, or local governmental agency. 

(16) Fees, (a) The state health agency may collect fees from patients who, pursuant 
to section 14 of article XVIII of the state constitution, apply to the medical marijuana 
program for a registry identification card for the purpose of offsetting the state health 
agency's direct and indirect costs of administering the program. The amount of the fees 
shall be set by rule of the state health agency. The amount of the fees set pursuant to this 
section shall reflect the actual direct and indirect costs of the state licensing authority in the 
administration and enforcement of this article so that the fees avoid exceeding the statutory 
limit on uncommitted reserves in administrative agency cash funds as set forth in section 
24-75-402 (3), C.R.S. The state health agency shall not assess a medical marijuana registry 
application fee to an applicant who demonstrates, pursuant to a copy of the applicant's state 
tax return certified by the department of revenue, that the applicant's income does not 
exceed one hundred eighty-five percent of the federal poverty line, adjusted for family size. 
All fees collected by the state health agency through the medical marijuana program shall 
be transferred to the state treasurer who shall credit the same to the medical marijuana 
program cash fund, which fund is hereby created. 

(b) Repealed. 

(17) Cash fund, (a) The medical marijuana program cash fund shall be subject to 
annual appropriation by the general assembly to the state health agency for the purpose of 
establishing, operating, and maintaining the medical marijuana program. All moneys 
credited to the medical marijuana program cash fund and all interest derived from the 
deposit of such moneys that are not expended during the fiscal year shall be retained in the 
fund for future use and shall not be credited or transferred to the general fund or any other 
fund. 

(b) (Deleted by amendment, L. 2010, (HB 10-1284), ch. 355, p. 1677, § 2, effective 
July 1, 2010.) 

(b.5) Notwithstanding any provision of paragraph (a) of this subsection (17) to the 
contrary, on June 30, 2011, the state treasurer shall deduct three million dollars from the 
medical marijuana program cash fund and transfer such sum to the general fund. 

(c) Repealed. 

(18) This section is repealed, effective July 1, 2019. 

Source: L. 2003: Entire article added with relocations, p. 686, § 2, effective July 1. 
L. 2009: (3) amended, (SB 09-208), ch. 149, p. 624, § 20, effective April 20. L. 2010: 
Entire section amended, (SB 10-109), ch. 356, p. 1691, § 1, effective June 7; (17)(b.5) 
added, (HB 10-1388), ch. 362, p. 1716, § 1, effective June 7; entire section amended, (HB 



Title 25 - page 87 Powers and Duties of the Department 25-1.5-108 

of Public Health and Environment 

10-1284), ch. 355, p. 1677, § 2, effective July 1. L. 2011: (2)(c)(II), (5)(a), and (16)(a) 
amended and (7)(e) added, (HB 11-1043), ch. 266, pp. 1211, 1212, §§ 19, 20, 22, 21, 
effective July 1. 

Editor's note: (1) This section is similar to former § 25-1-107 (l)(jj) as it existed prior to 2003. 

(2) Amendments to this section by Senate Bill 10-109 and House Bill 10-1284 were harmonized. 

(3) Subsection (17)(b.5) was added as subsection (3)(c) by House Bill 10-1388. That provision 
was harmonized with Senate Bill 10-109 and House Bill 10-1284 resulting in its relocation. 

(4) Subsection (3)(c)(II) provided for the repeal of subsection (3)(c), effective July 1, 201 1. (See 
L. 2010, p. 1677.) Subsections (16)(b)(II) and (17)(c)(II) provided for the repeal of subsections (16)(b) 
and (17)(c), respectively, effective July 1, 2012. (See L. 2010, p. 1691.) 

25-1.5-107. Pandemic influenza - purchase of antiviral therapy - definitions. 

(1) The department may enter into partnerships with one or more authorized purchasers 
to purchase antiviral therapy in order to acquire a ready supply or stockpile of antiviral 
drugs in the event of an epidemic emergency, including pandemic influenza. If an entity 
wishes to purchase antiviral therapy through the department, the entity shall notify the 
department of its intent and shall demonstrate to the department, in a form and manner 
determined by the department, that the entity satisfies the criteria of an authorized 
purchaser. Upon a determination that an entity is an authorized purchaser, the department 
shall seek approval from the United States department of health and human services for the 
purchase of antiviral therapy by the authorized purchaser. Any purchase of antiviral therapy 
shall be approved by the United States department of health and human services, and 
antiviral therapy shall be stored and used in accordance with state and federal requirements. 
(2) As used in this section, unless the context otherwise requires: 

(a) "Authorized purchaser" means an entity licensed by the department pursuant to 
section 25-1.5-103 (1) (a), a local public health agency, or a health maintenance organiza- 
tion, as defined in section 10-16-102 (23), C.R.S., authorized to operate in this state 
pursuant to part 4 of article 16 of title 10, C.R.S., that: 

(I) Is part of the state pandemic preparedness and response plan; 

(II) Will purchase antiviral therapy with its own funds; and 

(III) Agrees to stockpile the antiviral therapy for use in an epidemic emergency 
declared a disaster emergency pursuant to section 24-32-2104, C.R.S., and to use the 
antiviral therapy only in accordance with state and federal requirements and for no other 
purpose. 

(b) "Bioterrorism" means the intentional use of microorganisms or toxins of biological 
origin to cause death or disease among humans or animals. 

(c) "Emergency epidemic" means cases of an illness or condition, communicable or 
noncommunicable, caused by bioterrorism, pandemic influenza, or novel and highly fatal 
infectious agents or biological toxins. 

(d) "Pandemic influenza" means a widespread epidemic of influenza caused by a 
highly virulent strain of the influenza virus. 

Source: L. 2007: Entire section added with relocations, p. 1290, § 2, effective May 25. 

25-1.5-108. Regulation of dialysis treatment clinics - training for hemodialysis 
technicians - state board of health rules - definitions - repeal. (1) As used in this 
section, unless the context otherwise requires: 

(a) "Dialysis treatment clinic" means a health facility or a department or unit of a 
licensed hospital that is planned, organized, operated, and maintained to provide outpatient 
hemodialysis treatment to, or hemodialysis training for home use of hemodialysis equip- 
ment by, end-stage renal disease patients. 

(b) "End-stage renal disease" means the stage of renal impairment that appears 
irreversible and permanent and that requires a regular course of dialysis or a kidney 
transplant to maintain life. 

(c) "Hemodialysis technician" means a person who is not a physician or a registered 
nurse and who provides dialysis care. 



25-1.5-109 Health Title 25 - page 88 

(d) "National credentialing program" means any national program for credentialing or 
determining the competency of hemodialysis technicians that is recognized by the national 
association of nephrology technicians/technologists (NANT), or a successor association, 

(2) By January 1, 2008, the state board of health shall adopt rules to establish a process 
to verify that persons performing the duties and functions of a hemodialysis technician at 
or for a dialysis treatment clinic have been credentialed by a national credentialing program. 
The verification process shall be part of the department of public health and environment's 
licensing of dialysis treatment clinics and part of each routine survey of licensed dialysis 
clinics conducted by the department. As part of the rules adopted pursuant to this section, 
the state board shall establish fees consistent with section 25-3-105 to be assessed by the 
department against dialysis treatment clinics to cover the department's administrative costs 
in implementing this section. 

(3) (a) On and after January 1 , 2009, a person shall not act as, or perform the duties and 
functions of, a hemodialysis technician unless the person has been credentialed by a 
national credentialing program and is under the supervision of a licensed physician or 
licensed professional nurse experienced or trained in dialysis treatment. 

(b) On and after January 1, 2009, a dialysis treatment clinic licensed by the department 
shall not allow a person to perform the duties and functions of a hemodialysis technician at 
or for the dialysis treatment clinic if the person has not been credentialed by a national 
credentialing program. 

(c) Nothing in this subsection (3) shall prohibit: 

(I) A person from providing dialysis care to himself or herself or in-home, gratuitous 
dialysis care provided to a person by a friend or family member who does not represent 
himself or herself to be a hemodialysis technician; 

(II) A person participating in a hemodialysis technician training program from per- 
forming the duties and functions of a hemodialysis technician if: 

(A) The person is under the direct supervision of a physician, or a registered nurse 
experienced or trained in dialysis treatment, who is on the premises and available for 
prompt consultation or treatment; and 

(B) The person receives his or her credentials from a national credentialing program 
within eighteen months after the date the person enrolled in the training program. 

(4) In connection with its regulation of dialysis treatment clinics pursuant to section 
25-1.5-103 (1) (a) (I) and 25-3-101 (1) and rules adopted by the state board of health 
pursuant to subsection (2) of this section, on and after January 1, 2009, the department shall 
verify that a dialysis treatment clinic only employs hemodialysis technicians who have been 
credentialed by a national credentialing program. Compliance by a dialysis treatment clinic 
with this section shall be a condition of licensure by the department. 

(5) Each dialysis treatment clinic licensed by the department and operating in this state 
shall post a clear and unambiguous notice in a public location in the clinic specifying that 
the clinic is licensed, regulated, and subject to inspection by the Colorado department of 
public health and environment. The dialysis treatment clinic shall also inform consumers, 
either in the public notice required by this subsection (5) or in written materials provided 
to consumers, about the ability to provide feedback to the clinic and to the department, 
including the method by which consumers can provide feedback. The state board may adopt 
rules, as necessary, to specify the contents of the notice or written materials required by this 
subsection (5). 

(6) This section is repealed, effective September 1, 2019. Prior to this repeal, the 
department of regulatory agencies shall review the functions of the state board of health and 
the department regarding hemodialysis technicians as provided in section 24-34-104, C.R.S. 

Source: L. 2007: Entire section added with relocations, p. 1623, § 1, effective July 1. 
L. 2012: (2), (3)(a), and (6) amended, (HB 12-1204), ch. 103, p. 348, § 1, effective July 
1. 

25-1.5-109. Food allergies and anaphylaxis form for schools - powers and duties of 
department. The department has, in addition to all other powers and duties imposed upon 
it by law, the duty to develop, maintain, and make available to school districts and institute 



Title 25 - page 89 Powers and Duties of tiie Department 25-1 .5-202 

of Public Health and Environment 

charter schools a standard form to be used by school districts and institute charter schools 
to gather information from physicians and parents and guardians of students concerning 
students' risks of food allergies and anaphylaxis and the treatment thereof. The standard 
form shall include, at a minimum, fields for gathering the information described in section 
22-2-135 (3) (b), C.R.S. 

Source: L. 2009: Entire section added with relocations, (SB 09-226), ch. 245, p. 1106, 
§ 6, effective August 5. 

Cross references: For the legislative declaration contained in the 2009 act adding this section, see 
section 1 of chapter 245, Session Laws of Colorado 2009. 

PART 2 
POWERS AND DUTIES OF THE DEPARTMENT WITH RESPECT TO WATER 

25-1.5-201. Definitions. As used in this part 2, unless the context otherwise requires: 

(1) "Public water systems" means systems for the provision to the public of piped 
water for human consumption, if such system has at least fifteen service connections or 
regularly serves at least twenty-five individuals. Such term includes: 

(a) Any collection, treatment, storage, and distribution facilities under control of the 
operator of such system and used primarily in connection with such system; and 

(b) Any collection or pretreatment storage facilities not under such control which are 
used primarily in connection with such system. 

(2) "Supplier of water" means any person who owns or operates a public water system. 

Source: L. 2003: Entire article added with relocations, p. 687, § 2, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(x)(V) and (l)(x)(VI) as they existed 
prior to 2003. 

25-1.5-202. Water - minimum general sanitary standards. (1) The phrase "mini- 
mum general sanitary standards" as used in this part 2 and section 25-1-109 (1) (h) means 
the minimum standards reasonably consistent with assuring adequate protection of the 
public health, and, in the case of minimum general sanitary standards as to the quality of 
water supplied to the public, the same shall be established by rule and regulation and shall 
be appropriate to promote and protect the public health from endangerment presented by 
carcinogenic, mutagenic, teratogenic, pathogenic, or toxic contaminants or substances. 
Such standards shall be based on the best available endangerment assessment evidence and 
the best available treatment technology or methodology. The word "standards" as used in 
this part 2 and section 25-1-109 (1) (h) means standards reasonably designed to promote 
and protect the public health. 

(2) Minimum general sanitary standards for the quality of water supplied to the public 
shall be no more stringent than the drinking water standards promulgated pursuant to the 
federal "Safe Drinking Water Act", if such standards exist. If no standards have been 
promulgated pursuant to the federal "Safe Drinking Water Act" regarding the permissible 
concentration of any contaminant or any substance in drinking water, the department may 
recommend to the water quality control commission for promulgation minimum general 
sanitary standards regarding such contaminant or substance. 

(3) (a) The department shall annually establish and revise a priority list of contami- 
nants or substances for which standards may be considered and shall submit said list to the 
water quality control commission for review and approval. 

(b) The priority list of contaminants or substances, together with the department's 
evaluation of the considerations listed in this paragraph (b), shall be submitted to the water 
quality control commission for review and approval. The priority list shall be prepared 
according to a ranking process that incorporates the following considerations: 



25- 1 .5-203 Health Title 25 - page 90 

(I) The actual presence of a contaminant or substance in a drinking water supply system 
or the relative imminence of threat of contamination of a drinking water supply source; 

(II) The identifiability of a potential pathway or continued pathway of contamination; 

(III) The availabiUty of analytical techniques for measuring and identifying the con- 
taminant or substance in a reasonable manner; 

(IV) Sufficient available information concerning the contaminant or substance to allow 
an appropriate standard to be developed, including information on the health effects of the 
contaminant or substance as well as available treatment technology; 

(V) The magnitude of potential health risks of the contaminant or substance at 
reasonably anticipated exposure levels, utilizing the same exposure considerations, criteria 
for health risk, and criteria for data availability which are used by the criteria and standards 
division of the office of drinking water. United States environmental protection agency, in 
establishing the federal drinking water priority list; 

(VI) The fact that the contaminant or substance will be the subject of a national primary 
drinking water regulation in the near future; 

(VII) An analysis of the environmental fate and transport mechanisms within relevant 
environmental media; 

(VIII) Identification, characterization, and analysis of the populations and drinking 
water supplies at risk; and 

(IX) The level of effort and scope of work that will be necessary to develop sufficient 
data for the purpose of supporting an appropriate standard. 

(4) (a) Following the department's submission of recommended standards to the water 
quality control commission, the commission may promulgate standards for contaminants or 
substances that are not the subject of a standard set pursuant to the federal "Safe Drinking 
Water Act". 

(b) In the promulgation of such standards, the water quality control commission shall 
find that the standards are necessary to protect public health and have a demonstrated 
medical, technological, and scientific basis and that: 

(I) Based on credible medical and toxicological evidence that has been subjected to 
peer review, there exists a substantial risk to the public health; 

(II) The analytical techniques for measuring and identifying the contaminant or sub- 
stance are reasonably available; 

(III) The adverse health effects posed by the contaminant or substance are known to a 
reasonable degree of scientific certainty; and 

(IV) Compliance with such standard is feasible utilizing the best technology or meth- 
odology which is generally available. 

(5) All acts, orders, and rules adopted by the state board of health under the authority 
of this part 2 prior to July 1, 2006, that were valid prior to said date and not otherwise 
subject to judicial review shall, to the extent that they are not inconsistent with said 
provisions, be deemed and held to be legal and valid in all respects, as though issued by the 
water quality control commission under the authority of this part 2. No provision of this part 
2 shall be construed to validate any actions, orders, or rules that were not valid when 
adopted by the board of health prior to such date. 

Source: L. 2003: Entire article added with relocations, p. 687, § 2, effective July 1. 
L. 2006: (2), (3)(a), IP(3)(b), (4)(a), and IP(4)(b) amended and (5) added, p. 1127, § 2, 
effective July 1 . 

Editor's note: This secfion is similar to former § 25-1-107 (2) as it existed prior to 2003. 

25-1.5-203. Water - powers and duties of department. (1) The department has, in 
addifion to all other powers and duties imposed upon it by law, the powers and duUes 
provided in this secfion as follows: 

(a) Construction of community water facilities. To examine plans, specificafions, and 
other related data pertaining to the proposed construcfion of any publicly or privately owned 
community water facilities submitted for review of sanitary engineering features prior to 
construction of such facilities; 



Title 25 - page 91 Powers and Duties of the Department 25-1 .5-203 

of Public Health and Environment 

(b) Quality of drinking water. (I) To adopt and enforce minimum general sanitary 
standards and regulations to protect the quality of drinking water supplied to the public, 
including the authority to require disinfection and treatment of such water. 

(II) Standards and regulations adopted pursuant to this paragraph (b) may also include 
such minimum standards and regulations as are necessary to assume enforcement of the 
federal "Safe Drinking Water Act" with regard to public water systems, including, but not 
limited to, requirements for: 

(A) Review and approval by the department, prior to initiation of construction, of the 
technical plans and specifications, long-term financial plans, and operations and manage- 
ment plans for any new waterworks or technical plans and specifications for substantial 
modifications to existing waterworks. For the purposes of this subparagraph (II), "water- 
works" means the facilities that are directly involved in the production, treatment, or 
distribution of water for public water systems, as defined in section 141.2 of the national 
primary drinking water regulations. The department shall approve those new or substan- 
tially modified waterworks it determines are capable of complying with the Colorado 
primary drinking water regulations. . 

(B) Maintenance of records by the supplier of water relating to the results of tests and 
procedures required by the standards and regulations, including filing periodic reports with 
the department; 

(C) Public notification by the supplier of water, pursuant to the provisions of the federal 
"Safe Drinking Water Act"; 

(D) Granting exemptions and variances from the minimum general sanitary standards 
to allow appropriate time for compliance, when such procedure can be effected without 
seriously jeopardizing the public health. 

(c) Exemption of public water systems. (I) To exempt a water supplier from any 
further documentation requirements for purposes of establishing that it does not meet the 
definition of a public water system and is not subject to the requirements of the federal 
"Safe Drinking Water Act", where such water supplier has provided to the department 
evidence of the following: 

(A) An ordinance, resolution, contractual provision, or other similarly enforceable 
enactment that prohibits connection to the system for the purpose of obtaining water for 
human consumption; and 

(B) Either an annual visual inspection of the water supply system for the purpose of 
determining the presence of any unauthorized connections to the water supply system, or an 
annual written survey of those individuals or entities with whom the supplier has a 
contractual relationship governing the uses to which such water is placed by the contracting 
parties. 

(II) Nothing in subparagraph (I) of this paragraph (c) shall be construed to eliminate 
from the provisions of the federal "Safe Drinking Water Act" any exclusion that may 
otherwise be available under federal law or regulation. 

(d) Lab certification program for testing drinking water. (I) To establish and 
maintain a laboratory certification program for the purpose of ensuring competent testing of 
drinking water as required by the federal "Safe Drinking Water Act" and minimum general 
sanitary standards as set forth in section 25-1.5-202. Certification procedures shall, at a 
minimum, include water supply evaluation verification and on-site inspections. The labo- 
ratory certification program shall consist of certification levels which correspond to the 
testing capability and capacity of each laboratory. In addition to certifying laboratories for 
contaminants regulated as of May 11, 1988, the department shall adopt and implement a 
schedule for certifying sufficient laboratory capacity for the testing and analysis of 
contaminants for which reference methods are available and which are scheduled to be 
regulated under the federal "Safe Drinking Water Act". 

(II) Upon request, the department shall refer a public water supplier to a laboratory, 
either the department's or one certified by the department, which is determined to be 
equipped to perform the required testing and analysis on a timely basis. 

(III) To facilitate an effective laboratory certification program, the department shall 
work with local public water suppliers toward creating and maintaining a centralized data 
base which: 



25- 1 .5-204 Health Title 25 - page 92 

(A) Quantifies the current and expected demands for the monitoring, testing, and 
analysis of each supplier, grouped according to the size of the supply system, the source of 
its supply, and the requirements imposed on each supplier; 

(B) Includes an updated list of laboratories certified and available for the testing and 
analysis of specific contaminants; and 

(C) Tracks violations of drinking water standards for the purpose of facilitating an 
exchange among public water suppliers in addressing similar problems posed by specific 
contaminants. 

(e) Drinking water list. To cooperate with and assist the Colorado water resources and 
power development authority in the administration of the drinking water revolving fund 
created by section 37-95-107.8, C.R.S., including adopting rules governing the drinking 
water project eligibility list provided by said section and modifications to the eligibility list 
for submission to the general assembly, and to take any other actions necessary to assist the 
authority in complying with the requirements of the federal "Safe Drinking Water Act". 

Source: L. 2003: Entire article added with relocations, p. 689, § 2, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(r), (l)(x)(I), (l)(x)(II), (l)(x.2), 
(l)(x.5), and (l)(gg) as they existed prior to 2003. 

25-1.5-204. Inspection for violations of minimum general sanitary standards re- 
lating to quality of drinking water. (1) Upon presentation of proper credentials, autho- 
rized inspectors of the department may enter and inspect, at any reasonable time and in a 
reasonable manner, any property, premises, or place for the purpose of investigating any 
actual, suspected, or potential violations of minimum general sanitary standards adopted 
pursuant to section 25-1.5-202. Samples of drinking water may be obtained by such 
inspectors, and a portion of any samples to be used as evidence in an enforcement action 
shall be left with the owner, operator, or person in charge of the premises. A copy of the 
results of any analysis of such sample shall be furnished promptly to the owner, operator, 
or person in charge. 

(2) If such entry or inspection is denied or not consented to, the department is 
empowered to and shall obtain, from the district or county court for the judicial district or 
county in which such property, premises, or place is located, a warrant to enter and inspect 
said property, premises, or place. The said district and county courts of the state are 
empowered to issue such warrants upon a proper showing of the need for such entry and 
inspection, and a copy of any inspection report shall be provided the court within a 
reasonable time after making the inspection. 

Source: L. 2003: Entire article added with relocations, p. 691, § 2, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(x)(III) as it existed prior to 2003. 

25-1.5-205. Advice to other entities. The department may advise municipalities, 
utilities, institutions, organizations, and individuals concerning the methods or processes 
believed best suited to provide the protection or purification of water to meet minimum 
general sanitary standards adopted pursuant to section 25-1.5-202. 

Source: L. 2003: Entire article added with relocations, p. 691, § 2, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(x)(IV) as it existed prior to 2003. 

25-1.5-206. Applicability. (1) Except as otherwise provided in the federal "Safe 
Drinking Water Act", the provisions of this part 2 shall apply to each public water system 
in this state; except that the provisions of this part 2 shall not apply to a public water system 
that: 



Title 25 - page 93 Powers and Duties of the Department 25-1 .5-207 

of Public Health and Environment 

(a) Consists only of distribution and storage facilities (and does not have any collection 
and treatment facilities); 

(b) Obtains all of its water from, but is not owned or operated by, a public water system 
to which such regulations apply; 

(c) Does not sell water to any person; 

(d) Does not authorize incidental use of untreated water; and 

(e) Is not a carrier that conveys passengers in interstate commerce; or 

(f) Prohibits, through ordinance, resolution, or other enforceable enactment, the use of 
its system, or connections thereto, for the delivery of water to the public for human 
consumption, except to the extent that such user is a public water system subject to the 
provisions of this part 2. 

Source: L. 2003: Entire article added with relocations, p. 691, § 2, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(x)(VII) as it existed prior to 2003. 

25-1.5-207. Damages and injunctive relief to prevent or abate release of contami- 
nants in water. (1) (a) Except as provided in section 25-1-114.1 (3), any political 
subdivision or public water system which stores, releases, carries, conveys, supplies, or 
treats water for human consumption may bring suit to collect damages and for injunctive 
relief, in addition to all remedies otherwise available to prevent or abate any release or 
imminent release of contaminants or substances which, in water withdrawn for use, results 
or would likely result in: 

(1) A violation, at the point where the contaminant or substance enters or would enter 
the intake of the water treatment system of the same or another political subdivision or 
public water system, of any minimum general sanitary standard or regulation adopted 
pursuant to this part 2, and the existing treatment system cannot effectively treat the 
contaminant or substance in question so as to assure that treated water complies with such 
standard or regulation; or 

(II) Significant impairment of the normal operational capability of a water treatment 
system which meets the applicable specifications of the department for water treatment; or 

(III) Rendering the system's drinking water supply unfit for human consumption. 
Where there are no minimum general sanitary standards, water shall be deemed unfit for 
human consumption where it is shown that the risk of adverse human health effects from 
exposure to carcinogens in that water is greater than one times ten to the minus sixth power 
or greater than the acceptable levels of exposure to noncarcinogens as determined by the 
reference dose method. 

(b) Such an action may be maintained against any person who owns or operates the 
source or sources of the release of the contaminants, but no such action may be maintained 
with regard to surface or underground agricultural return flows except as otherwise 
provided in the "Colorado Chemigation Act", article 11 of title 35, C.R.S. Damages, 
including the costs of any remedy ordered or approved by the court shall include, as 
appropriate, those incurred in providing an interim substitute drinking water supply and 
monitoring and responding to the release or imminent release of contaminants or sub- 
stances. 

(2) Other remedies. Except as provided in this subsection (2), nothing in this section 
shall be construed to restrict or preempt any right which the state, the department, any 
public water system, or any other person may have under any other law to seek enforce- 
ment, in any court or in any administrative proceeding, of any provision of this section or 
any other relief regarding contamination of any drinking water supply. In addition, nothing 
in this section shall be construed to condition, restrict, or prevent any other civil or criminal 
actions which may be brought by the state or any political subdivision pursuant to any other 
state or federal statute or regulation or any local ordinance or regulation; except that, with 
respect to any release or substantial threat of release of a hazardous substance, pollutant, or 
contaminant addressed in pleadings or otherwise in a lawsuit brought pursuant to the federal 
"Comprehensive Environmental Response, Compensation and Liability Act", 42 U.S.C. 
sec. 9601 et seq., or by the terms and conditions of a remedial action plan, removal order. 



25- 1 .5-208 Health Title 25 - page 94 

consent decree, or other order or decree entered or issued by a court or administrative body 
of competent jurisdiction pursuant to such federal act, any person or entity which is a 
defendant in such a lawsuit or is subject to the terms and conditions of such a remedial 
action plan, removal order, consent decree, or other order or decree, shall not be subjected 
with respect to the same release or substantial threat of release of a hazardous substance, 
pollutant, or contaminant to any suit, action, or liability pursuant to section 25-1-114.1 (3); 
nor shall such person or entity be subject to any suit, action, or liability initiated or 
prosecuted by a political subdivision or a public water system pursuant to this section with 
respect to any release or substantial threat of release of a hazardous substance, pollutant, or 
contaminant which has been addressed by relief granted, or by measures implemented or 
legally required to be implemented, pursuant to a lawsuit brought pursuant to such federal 
act or the terms and conditions of a remedial action plan, removal order, consent decree, or 
other order or decree entered or issued by a court or administrative body of competent 
jurisdiction pursuant to such federal act. Nothing in this section shall be construed to bar a 
political subdivision or public water system from seeking to recover pursuant to applicable 
law its damages which have been reasonably incurred for the protection of the human health 
if enforceable arrangements to pay such damages have not otherwise been made. 

Source: L. 2003: Entire article added with relocations, p. 692, § 2, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(x)(VIII) as it existed prior to 2003. 

25-1.5-208. Grant program for drinking water and water treatment systems - 
small communities water and wastewater grant fund - rules. (1) The department has, 
in addition to all other powers and duties imposed upon it by law, the powers and duties 
provided in this section as follows: 

(a) To assist suppliers of water in the state with meeting their responsibilities with 
respect to protection of public health, the department, in the name of the state and to the 
extent that state funds are appropriated therefor, may enter into contracts with both 
governmental and not-for-profit public water systems, as defined in section 25-1.5-201 (1), 
or with counties representing unincorporated areas that serve a population of not more than 
five thousand people, to grant moneys for the planning, design, and construction of drinking 
water or water treatment systems. 

(b) The department may use up to five percent of the appropriated funds for the 
administration and management of such project grants. 

(2) The water quality control commission shall promulgate rules for the administration 
of any appropriated grant moneys pursuant to this section and for prioritizing proposed 
drinking water and water treatment system projects based upon public health impact and 
compliance with applicable rules. 

(3) During the grant application process, the department shall seek from the division of 
local government in the department of local affairs a fiscal analysis of the applying entity 
to determine financial need. Based upon its fiscal analysis, the division of local government 
shall issue or deny a certificate of financial need. If a certificate of financial need is issued, 
the department may authorize a state grant to the project in accordance with the project 
prioritization adopted by the department. 

(4) (a) There is hereby created in the state treasury the small communities water and 
wastewater grant fund, referred to in this subsection (4) as the "fund". The fund shall 
consist of moneys transferred pursuant to section 39-29-109 (2) (a) (III), C.R.S., and any 
other moneys transferred to the fund by the general assembly. The fund shall be used only 
for grants made pursuant to this section. All income derived from the deposit and 
investment of the moneys in the fund shall be credited to the fund. At the end of each fiscal 
year, all unexpended and unencumbered moneys in the fund shall remain in the fund and 
shall not revert to the general fund or to any other fund. 

(b) The revenues in the fund are continuously appropriated to the department for the 
purposes of this section. 



Title 25 - page 95 Powers and Duties of the Department 25-1.5-209 

of Public Health and Environment 

Source: L. 2003: Entire article added with relocations, p. 693, § 2, effective July 1. 
L. 2006: (2) amended, p. 1128, § 3, effective July 1. L. 2009: (l)(a) and (2) amended and 
(4) added, (SB 09-165), ch. 183, p. 803, § 1, effective April 22. 

Editor's note: This section is similar to former § 25-1-107 (l)(x)(IX) as it existed prior to 2003. 

25-1.5-209. Drinking water fee - drinking water cash fund. (1) 

2007, the division may assess an annual fee upon public water systems, 
shall be in accordance with the following schedule: 

Facility Categories and Subcategories for 
Drinking Water Fees 

(a) Category 01 Community surface water systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 

Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population from 30,001 - 100,000 

Subcategory 8 Population from 100,001 - 200,000 

Subcategory 9 Population from 200,001 - 500,000 

Subcategory 10 Population greater than 500,000 

(b) Category 02 Community groundwater systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 

Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population greater than 30,001 

(c) Category 03 Community-purchased surface water or 

groundwater systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 

Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population greater than 30,001 

(d) Category 04 Nontransient, noncommunity surface water systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 

Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population greater than 30,001 

(e) Category 05 Nontransient, noncommunity groundwater systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 



Effective , 


July 1, 


and all such fees 


Annual Fees 


$ 


75 


$ 


100 


$ 


310 


$ 


465 


$ 


865 


$ 


1,850 


$ 


4,940 


$ 


9,270 


$ 


15,450 


$ 21,630 


$ 


75 


$ 


100 


$ 


220 


$ 


310 


$ 


680 


$ 


1,545 


$ 


4,450 


$ 


75 


$ 


100 


$ 


155 


$ 


250 


$ 


490 


$ 


865 


$ 


2,470 


ms 

$ 


75 


$ 


100 


$ 


280 


$ 


400 


$ 


620 


$ 


1,670 


$ 


4,450 


ns 

$ 


75 


$ 


100 


$ 


155 


$ 


245 


$ 


495 



25-1.5-209 Health 



Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population greater than 30,001 

(f) Category 06 Nontransient, noncommunity-purchased surface 

water or groundwater systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 

Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population greater than 30,001 

(g) Category 07 Transient, noncommunity surface water systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 

Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population greater than 30,001 

(h) Category 08 Transient, noncommunity groundwater systems 

Subcategory 1 Population from 25 - 250 

Subcategory 2 Population from 251 - 500 

Subcategory 3 Population from 501 - 1,000 

Subcategory 4 Population from 1,001 - 3,300 

Subcategory 5 Population from 3,301 - 10,000 

Subcategory 6 Population from 10,001 - 30,000 

Subcategory 7 Population greater than 30,001 $ 2,970 

(i) Category 09 Transient, noncommunity-purchased surface water 
or groundwater systems 

Subcategory 1 Population from 25 - 250 $ 75 

Subcategory 2 Population from 251 - 500 $ 100 

Subcategory 3 Population from 501 - 1,000 $ 110 

Subcategory 4 Population from 1,001 - 3,300 $ 125 

Subcategory 5 Population from 3,301 - 10,000 $ 310 

Subcategory 6 Population from 10,001 - 30,000 $ 435 

Subcategory 7 Population greater than 30,001 $ 1,490 

(2) All fees collected pursuant to this section shall be transmitted to the state treasurer, 
who shall credit them to the drinking water cash fund, which fund is hereby created in the 
state treasury. Moneys so collected shall be annually appropriated by the general assembly 
to the department for allocation to the division of administration to operate the drinking 
water program established in this part 2. The general assembly shall review expenditures of 
such moneys to assure that they are used only for such purposes. All interest earned on the 
investment or deposit of moneys in the cash fund and all unappropriated or unencumbered 
moneys in the cash fund shall remain in the cash fund and shall not revert to the general 
fund or any other fund at the end of any fiscal year or any other time. Any funds remaining 
from fees collected prior to the repeal of former section 25-1.5-209, as it existed prior to 
July 1, 2005, shall be transmitted to the state treasurer, who shall credit the same to the cash 
fund. 

Source: L. 2003: Entire section added with relocations, p. 1502, § 2, effective May 1. 
L. 2007: Entire section RC&RE, p. 1455, § 3, effective July 1. 

Editor's note: Subsection (4) provided for the repeal of this section, effective July 1, 2005. (See 
L. 2003, p. 1502.) 



Title 25 - page 96 


$ 


1,360 


$ 3,650 


$ 


75 


$ 


100 


$ 


125 


$ 


185 


$ 


325 


$ 


805 


$ 


1,980 


$ 


75 


$ 


100 


$ 


245 


$ 


310 


$ 


555 


$ 


620 


$ 3,960 


$ 


75 


$ 


100 


$ 


125 


$ 


185 


$ 


495 


$ 


535 



Title 25 - page 97 Powers and Duties of the Department 25-1.5-301 

of Public Health and Environment 

PART 3 
ADMINISTRATION OF MEDICATIONS 

25-1.5-301. Definitions. As used in this part 3, unless the context otherwise requires: 

(1) "Administration" means assisting a person in the ingestion, application, inhalation, 
or, using universal precautions, rectal or vaginal insertion of medication, including pre- 
scription drugs, according to the legibly written or printed directions of the attending 
physician or other authorized practitioner or as written on the prescription label and making 
a written record thereof with regard to each medication administered, including the time and 
the amount taken, but "administration" does not include judgment, evaluation, or assess- 
ments or the injections of medication, the monitoring of medication, or the self-adminis- 
tration of medication, including prescription drugs and including the self-injection of 
medication by the resident. "Administration" also means ingestion through gastrostomy 
tubes or naso-gastric tubes, if administered by an individual authorized pursuant to section 
27-10.5-103 (2) (k), C.R.S., as part of residential or day program services provided through 
service agencies approved by the department of human services and supervised by a 
licensed physician or nurse. 

(2) "Facility" means: 

(a) The correctional facilities under the supervision of the executive director of the 
department of corrections including, but not limited to: 

(I) Those facilities provided for in article 20 of title 17, C.R.S.; 

(II) Minimum security facilities provided for in article 25 of title 17, C.R.S.; 

(III) Jails provided for in article 26 of title 17, C.R.S.; 

(IV) Community correctional facilities and programs provided for in article 27 of title 
17, C.R.S.; 

(V) The regimented inmate discipline and treatment program provided for in article 
27.7 of title 17, C.R.S.; and 

(VI) The Denver regional diagnostic center provided for in article 40 of title 17, C.R.S.; 

(b) Institutions for juveniles provided for in part 4 of article 2 of title 19, C.R.S.; 
(b.5) Assisted Uving residences as defined in section 25-27-102 (1.3); 

(c) Adult foster care facilities provided for in section 26-2-122.3, C.R.S.; 

(d) Alternate care facilities provided for in section 25.5-6-303 (3), C.R.S.; 

(e) Residential child care facilities for children as defined in section 26-6-102 (8), 
C.R.S.; 

(f) Secure residential treatment centers as defined in section 26-6-102 (9), C.R.S.; 

(g) Facilities that provide treatment for persons with mental illness as defined in section 
27-65-102 (7), C.R.S., except for those facilities which are publicly or privately licensed 
hospitals; 

(h) All services funded through and regulated by the department of human services 
pursuant to article 10.5 of title 27, C.R.S., in support of persons with developmental 
disabilities; and 

(i) Adult day care facilities providing services in support of persons as defined in 
section 25.5-6-303 (1), C.R.S. 

(3) "Monitoring" means: 

(a) Reminding the resident to take medication or medications at the time ordered by the 
physician or other authorized licensed practitioner; 

(b) Handing a resident a container or package of medication lawfully labeled previ- 
ously for the individual resident by a licensed physician or other authorized licensed 
practitioner; 

(c) Visual observation of the resident to ensure compliance; 

(d) Making a written record of the resident's compliance with regard to each medica- 
tion, including the time taken; and 

(e) Notification to the physician or other authorized practitioner if the resident refuses 
to or is not able to comply with the physician's or other practitioner's instructions with 
regard to the medication. 

(4) "Qualified manager" means a person who: 



25-1.5-302 Health Title 25 - page 98 

(a) Is the owner or operator of the facility or a supervisor designated by the owner or 
operator of the facility for the purpose of implementing section 25-1.5-303; and 

(b) Has completed training in the administration of medications pursuant to section 
25-1.5-303 or is a licensed nurse pursuant to article 38 of title 12, C.R.S., a licensed 
physician pursuant to article 36 of title 12, C.R.S., or a licensed pharmacist pursuant to 
article 42.5 of title 12, C.R.S. Every unlicensed person who is a "quahfied manager" within 
the meaning of this subsection (4) shall, every four years, successfully complete a test 
approved by the department pertaining to the administration of medications. 

(5) "Self- administration" means the ability of a person to take medication indepen- 
dently without any assistance from another person. 

Source: L. 2003: Entire article added with relocations, p. 694, § 2, effective July 1. 
L. 2006: (2)(d) and (2)(i) amended, p. 2014, § 86, effective July 1; (2)(g) amended, p. 
1405, § 64, effective August 7. L. 2010: (2)(g) amended, (SB 10-175), ch. 188, p. 798, 
§ 60, effective April 29. L. 2012: (4)(b) amended, (SB 12-1311), ch. 281, p. 1627, § 70, 
effective July 1. 

Editor's note: This section is similar to former § 25-1-107 (l)(ee)(1.5)(A), (l)(ee)(I.5)(B), 
(l)(ee)(II), (l)(ee)(II.5), and (l)(ee)(III)(A) as it existed prior to 2003. 

25-1.5-302. Administration of medications - powers and duties of department - 
criminal history record checks. (1) The department has, in addition to all other powers 
and duties imposed upon it by law, the power and duty to establish and maintain by rule and 
regulation a program for the administration of medications in facilities, which program shall 
be developed and conducted by the department of human services and the department of 
corrections, as provided in this part 3, within the following guidelines: 

(a) As a condition to authorizing or renewing the authorization to operate any facility 
that administers medications to persons under its care, the authorizing agency shall require 
that the facility have a staff member qualified pursuant to paragraph (b) of this subsection 
(1) on duty at any time that the facility administers such medications and that the facility 
maintain a written record of each medication administered to each resident, including the 
time and the amount of the medication. Such record will be subject to review by the 
authorizing agency as a part of its procedure in authorizing the continued operation of the 
facility. Notwithstanding any exemption enumerated in paragraph (b) of this subsection (1), 
any facility may establish a policy which requires a person authorized to administer 
medication to report to, be supervised by, or to be otherwise accountable for the perfor- 
mance of such administration to a registered nurse as defined in section 12-38-103, C.R.S. 

(b) Any individual who is not otherwise authorized by law to administer medication in 
a facility shall be allowed to perform such duties only after passing a competency 
evaluation. An individual who administers medications in facilities in compliance with the 
provisions of this part 3 shall be exempt from the licensing requirements of the "Colorado 
Medical Practice Act", the "Nurse Practice Act", and the laws of this state pertaining to 
possession of controlled substances as contained in article 42.5 of title 12, C.R.S., part 2 of 
article 80 of title 27, C.R.S., or the "Uniform Controlled Substances Act of 1992", article 
18 of title 18, C.R.S. 

(2) The department, in cooperation with appropriate agencies or advisory bodies, shall 
develop or approve training curricula and competency evaluation procedures for those who 
administer medications in facilities. 

(3) If either the department of human services or the department of corrections wishes 
to use a different training curriculum and competency evaluation procedure for those who 
administer medications in the facilities whose operation is authorized by those departments, 
such department shall ensure that such training curriculum and competency evaluation 
procedure are first submitted to the department of public health and environment for its 
review. If, after such review, the department of public health and environment has no 
objection, the submitting department shall assume responsibility for the cost and imple- 
mentation of such curriculum and evaluation in keeping with the other provisions of this 
medications administration program for those facilities whose operation is authorized by 



Title 25 - page 99 Powers and Duties of the Department 25-1.5-302 

of Public Health and Environment 

such department. Any department that administers competency evaluations shall maintain 
a list of those who have successfully completed such competency evaluation and shall 
forward a copy of such list to the department of public health and environment within 
forty-five days after administration of such evaluation. 

(4) The department shall assure that training sessions, each followed by a competency 
evaluation set to measure basic competency only, are offered at various geographic 
locations in the state. An individual who does not pass the competency evaluation may 
apply to retake it. An appropriate fee must be paid each time the competency evaluation is 
taken. An individual may apply for and take the competency evaluation only once without 
having first attended a training session approved by the department. If such individual fails 
to meet a minimum competency level on such first evaluation, the applicant must attend an 
approved training session before again taking the competency evaluation. 

(5) The department shall set and collect a uniform fee for any training session given and 
a uniform fee for any competency evaluation administered under the provisions of this 
section whether the department administers such training or testing or contracts with a 
private provider pursuant to subsection (7) of this section, so that the revenue generated 
from such fees approximates the direct and indirect costs incurred by the department in the 
performance of its duties under this section. No person shall enroll in a training session or 
take the competency evaluation test until such person applies and makes payment of the 
appropriate fees to the department. 

(6) If the individual authorized to administer medication pursuant to subsection ( 1 ) of 
this section is found, during the course of any review by the authorizing agency as part of 
its procedure in authorizing the continued operation of the facility, to be unable or unwilling 
to comply with the training regimen established for medication administration, the depart- 
ment may order retraining as a remedial measure. 

(7) (a) If the department determines that it is not able to provide the training and 
administer competency evaluations pursuant to this section, the department may contract 
with a private provider or instructor to provide such training and administer such compe- 
tency evaluations. 

(b) Before any private contractor may offer training pursuant to this subsection (7), 
such private contractor shall be reviewed by the department. Only those private contractors 
approved by the department may offer training. Any such approved private contractor shall 
offer only a medication administration training program which has been approved by the 
department. The department shall maintain a list of approved medication administration 
contractors. The department shall compensate contractors from the fees collected from each 
trainee in attendance at any such privately contracted training session or competency 
evaluation. 

(c) All private contractors shall provide the department with a list of all persons who 
have taken such contractor's approved training sessions or have passed the competency 
evaluation or both. Such contractors shall also provide the department with any other 
pertinent information reasonably requested by the department pursuant to its obligations 
and authority under this section. The department shall maintain a listing of all persons who 
have passed the competency evaluation on its web site. 

(8) Each owner, operator, or supervisor of a facility who employs a person who is not 
licensed to administer medications shall conduct a drug-related criminal background check 
on each employee prior to employment. 

Source: L. 2003: Entire article added with relocations, p. 696, § 2, effective July 1. 
L. 2009: (7)(c) amended and (8) added, (SB 09-128), ch. 365, p. 1915, § 6, effective July 
1. L. 2012: (l)(b) amended, (HB 12-1311), ch. 281, p. 1627, § 71, effective July 1. 

Editor's note: This secfion is similar to former § 25-1-107 (l)(ee)(I) and (l)(ee)(1.3) as they 
existed prior to 2003. 

Cross references: For the "Colorado Medical Practice Act", see article 36 of dtle 12; for the 
"Nurse Practice Act", see article 38 of fitle 12. 



25-1.5-303 Health Title 25 - page 100 

25-1.5-303. Medication reminder boxes or systems - medication cash fund. 

(1) Medication reminder boxes or systems may be used if such containers have been filled 
and properly labeled by a pharmacist licensed pursuant to article 42.5 of title 12, C.R.S., a 
nurse licensed pursuant to article 38 of title 12, C.R.S., or an unlicensed person trained 
pursuant to this section or filled and properly labeled through the gratuitous care by 
members of one's family or friends. Nothing in this section authorizes or shall be construed 
to authorize the practice of pharmacy, as defined in section 12-42.5-102 (31), C.R.S. No 
unlicensed person shall fill and label medication reminder boxes pursuant to this section 
until such person has completed appropriate training approved by the department, and no 
facility shall use an unlicensed person to perform such services unless such facility has a 
qualified manager to oversee the work of such unlicensed person or persons. Every 
unlicensed person and qualified manager described in this section shall sign a disclosure 
statement under penalty of perjury stating that he or she never had a professional license to 
practice nursing, medicine, or pharmacy revoked in this or any other state for reasons 
directly related to the administration of medications. 

(2) The department has, in addition to all other powers and duties imposed upon it by 
law, the powers and duties provided in this section to develop and implement policies and 
procedures with respect to the provisions in subsection ( 1 ) of this section concerning the 
administration of medication reminder boxes. 

(3) The executive directors of the departments that control the "facilities" defined in 
section 25-1.5-301 (2) (a) and (2) (b) may direct the unlicensed staff of any such facility to 
monitor medications in any part of any such facility. Administration of medications in any 
such facility shall be allowed only in those areas of any such facility that have a licensed 
physician or other licensed practitioner on duty. Notwithstanding other training require- 
ments established in this section, the operator or administrator of every facility that hires an 
unlicensed person to administer medications pursuant to this section shall provide on-the- 
job training for such person, and all such unlicensed persons hired on or after July 1, 1998, 
shall be adequately supervised until they have completed such training. Such on-the-job 
training shall be appropriate to the job responsibilities of each trainee. Facility operators and 
administrators shall require each unlicensed person who administers medication in the 
facility to pass the competency evaluation developed or approved by the department 
pursuant to section 25-1.5-302 (2) as a condition of employment in that facility at least once 
every five years. Facility operators and administrators shall document each unlicensed 
person's satisfactory completion of on-the-job training and passage of the competency 
evaluation in his or her permanent personnel file. 

(4) A person who self-administers medication is personally responsible for medication 
administration. No facility shall be responsible for observing or documenting the self- 
administration of medication. Compliance with the requirements for the training of unli- 
censed persons in medication administration pursuant to this section is not required when 
persons being cared for are self-administering. 

(5) (a) All fees collected pursuant to this section shall be transmitted to the state 
treasurer, who shall credit the same to the medication administration cash fund, which fund 
is hereby created. 

(b) The general assembly shall make annual appropriations from the medication 
administration cash fund for expenditures of the department incurred in the performance of 
its duties under this section. 

(c) Any moneys collected by the department from persons taking a training program or 
a competency examination from a private contractor approved pursuant to section 25-1.5- 
302 (7) shall be transmitted to the state treasurer, who shall credit the same to the 
medication administration cash fund created in paragraph (a) of this subsection (5). Such 
moneys collected from the fees charged for any such training program or competency 
examination shall be annually appropriated by the general assembly to the department for 
the purpose of paying private contractors for services rendered and for paying the depart- 
ment's direct and indirect costs incurred pursuant to section 25-1.5-302 (7). 

(d) In accordance with section 24-36-114, C.R.S. , all interest derived from the deposit 
and investment of the medication administration cash fund created in paragraph (a) of this 
subsection (5) shall be credited to the general fund. 



Title 25 -page 101 



Vital Statistics 



25-1.5-304 



Source: L. 2003: Entire article added with relocations, p. 697, § 2, effective July 1. 
L. 2009: (3) amended, (SB 09-128), ch. 365, p. 1914, § 5, effective July 1. L. 2012: (1) 
amended, (HB 12-1311), ch. 281, p. 1628, § 72, effective July 1. 

Editor's note: This section is similar to former § 25-1-107 IP(l)(ee)(I.5), (l)(ee)(1.6), 
(l)(ee)(III)(B), (l)(ee)(IV), (l)(ee)(IV.5), and (l)(ee)(V) as they existed prior to 2003. 

25-1.5-304. Repeal of part. (Repealed) 

Source: L. 2003: Entire article added with relocations, p. 699, § 2, effective July 1. 
L. 2009: Entire section repealed, (SB 09-128), ch. 365, p. 1913, § 1, effective July 1. 

Editor's note: Prior to its repeal in 2009, this section was similar to former § 25-1-107 (l)(ee)(VI) 
and (l)(ee)(VII) as they existed prior to 2003. 

VITAL STATISTICS 

ARTICLE 2 

Vital Statistics 

Editor's note: This article was numbered as article 8 of chapter 66, C.R.S. 1963. The substantive 
provisions of this article were repealed and reenacted in 1967, resulting in the addition, relocation, and 
elimination of sections as well as subject matter For amendments to this article prior to 1967, consult 
the Colorado statutory research explanatory note beginning on page vii in the front of this volume. 



25-2-101. 


Short title. 




nancy - legislative declara- 


25-2-102. 


Definitions. 




tion. 


25-2-103. 


Centralized registration sys- 


25-2-112. 


Certificates of birth - filing - 




tem for all vital statistics - 




establishment of paternity. 




appointment of registrar - 


25-2-112.3. 


Certificates of stillbirth - fil- 




rules. 




ing - delayed registration - 


25-2-104. 


Registration of vital statistics. 




rules. 


25-2-105. 


Vital statistics, reports, and 


25-2-112.5. 


Social security account num- 




certificates - forms and in- 




bers - acknowledgments of 




formation to be included. 




paternity - to be furnished. 


25-2-106. 


Reports of marriage. 


25-2-113. 


New certificates of birth fol- 


25-2-107. 


Reports of adoption, dissolu- 




lowing adoption - legitima- 




tion of marriage, parentage, 




tion - parentage determina- 




and other court proceedings 




tion. 




affecting vital statistics - tax 


25-2-113.5. 


Limited access to information 




on court action affecting 




upon consent of all parties - 




vital statistics. 




voluntary adoption registry. 


25-2-108. 


Reports and certificates as to 


25-2-114. 


Delayed registration of births 




births and deaths. (Re- 




and deaths. 




pealed) 


25-2-115. 


Alteration of reports and cer- 


25-2-109. 


Local registration districts for 




tificates - amended reports 




processing of birth and 




and certificates. 




death certificates. (Re- 


25-2-116. 


Institutions to keep records - 




pealed) 




persons to furnish informa- 


25-2-110. 


Certificates of death - repeal. 




tion. 


25-2-110.5. 


Fetal deaths - treatment of 


25-2-117. 


Certified copies furnished - 




remains. 




fee. 


25-2-111. 


Dead bodies - disposition - 


25-2-118. 


Penalties. 




removal from state - re- 


25-2-119. 


Tax on court action affecting 




cords. 




vital statistics. (Repealed) 


25-2-111.5. 


Transfer of fetal tissue from 


25-2-120. 


Reports of electroconvulsive 




induced termination of preg- 




treatment. 



25-2-101 Health Title 25 - page 102 

25-2-121. Fee adjustments - vital statis- 25-2-122. Heirloom birth and marriage 

tics records cash fund ere- certificates - funds created - 

ated. report - rules - definitions. 

25-2-101. Short title. This article shall be known and may be cited as the "Vital 
Statistics Act of 1984". 

Source: L. 67: R&RE, p. 1056, § 1. C.R.S. 1963: § 66-8-1. L. 84: Entire section 
amended, p. 742, § 2, effective July 1. 

ANNOTATION 

Law reviews. For article, "Curative Statutes This article is a valid exercise of the police 

of Colorado Respecting Tides to Real Estate", power of the state, and it operates in all parts of 

see 16 Dicta 35 (1939). For article, "Transsexu- the state, including Denver and other home-rule 

als — Their Legal Sex", see 40 U. Colo. L. Rev. cities. People ex rel. Hershey v. McNichols, 91 

282 (1968). Colo. 141, 13 R2d 266 (1932). 

25-2-102. Definitions. As used in this article, unless the context otherwise requires: 

(1) "Dead body" means a lifeless human body or parts of such body or bones thereof 
from the state of which it reasonably may be concluded that death recently occurred. 

(2) "Fetal death" means death prior to the complete expulsion or extraction from its 
mother of a product of human conception, irrespective of the duration of pregnancy. The 
death is indicated by the fact that after such expulsion or extraction the fetus does not 
breathe or show any other evidence of life such as beating of the heart, pulsation of the 
umbilical cord, or definite movement of voluntary muscles. 

(2.5) "Final disposition" means the burial, interment, cremation, removal from the 
state, or other authorized disposition of a dead body or fetus. 

(2.7) "Induced termination of pregnancy" means the purposeful interruption of a 
pregnancy with an intention other than producing a live-born infant or removing a dead 
fetus and that does not result in a live birth. 

(3) "Institution" means any establishment which provides inpatient medical, surgical, 
or diagnostic care or treatment or nursing, custodial, or domiciliary care to two or more 
unrelated individuals or to which persons are committed by law. 

(3.5) "Physician" means a person licensed to practice medicine in Colorado pursuant 
to article 36 of title 12, C.R.S. 

(4) "Regulations" means regulations duly adopted pursuant to section 25-2-103. 
(4.5) "Stillborn death" or "stillbirth" means death prior to the complete expulsion or 

extraction from its mother of a product of human conception, occurring after the twentieth 
week of pregnancy, and does not include "induced termination of pregnancy", as defined 
by subsection (2.7) of this section. The death is indicated by the fact that after such 
expulsion or extraction the fetus does not breathe or show any other evidence of life such 
as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary 
muscles. 

(5) "Vital statistics certificate" means any certificate required by section 25-2-110, 
25-2-112, or 25-2-112.3. 

(6) "Vital statistics report" means any report required by section 25-2-106 or 25-2-107. 

Source: L. 67: R&RE, p. 1056, § 1. C.R.S. 1963: § 66-8-2. L. 84: (2.5) and (3.5) 

added and (6) amended, p. 742, § 3, effective July 1. L. 2000: (2.7) added, p. 1073, § 1, 
effective August 2. L. 2001: (4.5) added, p. 439, § 1, effective August 8. L. 2004: (4.5) 
and (5) amended, p. 473, § 1, effective July 1. 

Editor's note: Subsection (4.5) was originally numbered as (3.7) in House Bill 01-1325 but has 
been renumbered on revision for ease of location. 



Title 25 - page 103 Vital Statistics 25-2-103 

ANNOTATION 

Limitation on definition of "fetal death". expiration as the only form of death. It is solely 

The definition of "fetal death" in this section a definition of fetal death. Lovato v. District 

does not indicate an intent on the part of the Court, 198 Colo. 419, 601 P.2d 1072 (1979). 
general assembly generally to recognize somatic 

25-2-103. Centralized registration system for all vital statistics - appointment of 
registrar - rules. (1) In order to provide for the maintenance of a centralized registry of 
the vital statistics of this state, the office of state registrar of vital statistics, referred to in 
this article as the "state registrar", is hereby created in the department of public health and 
environment. The state registrar shall be appointed by the state board of health and shall 
have such staff and clerical help as reasonably may be required in the performance of the 
state registrar's duties. The state registrar and the staff and clerical help of the state registrar 
shall be subject to the state constitution and state personnel system laws. 

(2) The state board of health shall adopt, promulgate, amend, and repeal such rules and 
orders in accordance with the provisions of section 24-4-103, C.R.S., as are necessary and 
proper for carrying out the provisions of this article. 

(3) (a) The state registrar shall direct and supervise the operation of the vital statistics 
system, prepare and publish annual reports of vital statistics, and administer and enforce the 
provisions of this article and all rules issued under this article. 

(b) In conjunction with the requirements of paragraph (a) of this subsection (3), the 
state registrar shall collect the name of the provider of prenatal care, if any, and the name 
of the provider of initial delivery services and shall require that such information be 
reported on all birth certificates. In addition, whenever an investigation or inquest is 
conducted pursuant to section 30-10-606, C.R.S., concerning the death of a child under one 
year of age, the coroner shall forward the information described in this paragraph (b) to the 
state registrar for inclusion on the death certificate of the subject of the inquest or 
investigation. 

(4) Federal, state, local, and other public or private agencies may, upon request, be 
furnished copies of records of data for statistical purposes upon such terms and conditions 
as may be prescribed by regulation. 

(5) The state registrar shall designate organized county, district, or municipal public 
health agencies established pursuant to part 5 of article 1 of this title and may establish or 
designate additional offices throughout Colorado to aid in the efficient administration of the 
system of vital statistics. 

(6) The state registrar may: 

(a) Require departments or offices so designated or established to comply with perfor- 
mance and accounting standards as set forth in rules promulgated by the state board of 
health; 

(b) Delegate such functions and duties to the staff and clerical help and to any offices 
established or designated by the state registrar pursuant to this section as deemed necessary 
or expedient; 

(c) Conduct training programs to promote the uniformity of the administration of this 
article throughout Colorado. 

Source: L. 67: R&RE, p. 1057, § 1. C.R.S. 1963: § 66-8-3. L. 76: Entire section 
amended, p. 309, § 48, effective May 20. L. 84: Entire section amended, p. 743, § 4, 
effective July 1. L. 94: Entire section amended, p. 2748, § 398, effective July 1. L. 96: 
Entire section amended, p. 401, § 13, effective April 17. L. 2010: (5) amended, (HB 
10-1422), ch. 419, p. 2092, § 87, effective August 11. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 



25-2-104 



Health 
ANNOTATION 



Title 25 -page 104 



Annotator's note. Since provisions similar to 
those in repealed § 25-2-109 were included in 
this section when it was amended in 1984, the 
applicable annotations under the repealed sec- 
tion have been included in the annotations to 
this section. 

Purpose of this section is to place the state 
system of registration of births and deaths in 
charge of the state board of health with power to 
appoint local registrars. McNichols v. People ex 
rel. Hershey, 92 Colo. 469, 22 P.2d 131 (1933). 

Section supersedes municipal ordinances. 
And so far as local registrars of vital statistics 
are concerned, municipal ordinances are super- 
seded by this section. McNichols v. People ex 
rel. Hershey, 92 Colo. 469, 22 P2d 131 (1933). 



Birth certificate certified by the local reg- 
istrar is as dependable as one certified by the 
state registrar, since it is the former who fur- 
nishes the information to the latter. Trujillo v. 
People, 122 Colo. 436, 222 P2d 775 (1950). 

Effect of failure to appoint local registrar. 
Under former provision, failure of the state 
board of health to appoint a local registrar of 
vital statistics for Denver for a number of years 
did not deprive it of its statutory power to ap- 
point, nor relieve it of the necessity of perform- 
ing a plain statutory duty. McNichols v. People 
ex rel. Hershey, 92 Colo. 469, 22 P2d 131 
(1933). 



25-2-104. Registration of vital statistics. Promptly upon receipt of each vital statistics 
report or certificate, the state registrar shall examine it to determine that it has been properly 
completed. If the report has been properly completed, the state registrar shall register the 
statistical event described therein and shall note the date the report has been accepted as 
having been properly completed and shall place the same, or a reproduction thereof, made 
in accordance with section 25-2-1 17 (3), in the permanent files of the office. If not properly 
completed, the state registrar shall take such action with respect thereto as may be required 
by applicable regulations. 



Source: L. 67: R&RE, p. 1057, § 
amended, p. 743, § 5, effective July 1 



C.R.S. 1963: § 66-8-4. L. 84: Entire section 



25-2-105. Vital statistics, reports, and certificates - forms and information to be 
included. The state registrar shall prescribe, furnish, and distribute such forms as are 
required by this article and shall furnish and distribute such rules and regulations as are 
promulgated pursuant to section 25-2-103. The state registrar may also prescribe such other 
means for transmission of data as will accomplish the purpose of complete and accurate 
reporting and registration. 

Source: L. 67: R&RE, p. 1057, § 1. C.R.S. 1963: § 66-8-5. L. 84: Entire section 
R&RE, p. 744, § 6, effective July 1. 

ANNOTATION 

Law reviews. For article, "Transsexuals — 
Their Legal Sex", see 40 U. Colo. L. Rev. 282 
(1968). 

25-2-106. Reports of marriage. Each county clerk and recorder shall prepare a report 
containing such information and using such form as may be prescribed and furnished by the 
state registrar with respect to every duly executed marriage certificate that is returned in 
accordance with section 14-2-109, C.R.S. On or before the tenth day of each month, or more 
frequently if so requested by the state registrar, such clerk and recorder shall forward to the 
state registrar all such marriage reports for all marriage certificates returned in the preceding 
period. Certified copies of marriage certificates may be issued by any clerk and recorder. 



Source: L. 67: R&RE, p. 1057, § 1. C.R.S. 1963: § 66-8-6. 



Title 25 - page 105 Vital Statistics 25-2-1 10 

25-2-107. Reports of adoption, dissolution of marriage, parentage, and other court 
proceedings affecting vital statistics - tax on court action affecting vital statistics. 

(1) The clerk of each court or, for parentage proceedings, the clerk of the court or a 
delegate child support enforcement unit shall prepare a report containing such information 
and using such form as may be prescribed and furnished by the state registrar with respect 
to every decree entered by the court with respect to parentage, legitimacy, adoption, change 
of name, dissolution of marriage, legal separation, or declaration of invalidity of marriage 
and every decree amending or nullifying such a decree and also with respect to every decree 
entered pursuant to section 25-2-114. On or before the tenth day of each month, or more 
frequently if so requested by the state registrar, such clerk shall forward to the state registrar 
the reports for all such decrees entered during the preceding period. 

(2) In order to help defray the maintenance of vital statistics records, there shall be 
levied, in addition to the tax levied under section 2-5-119, C.R.S., a tax of three dollars upon 
each action with respect to parentage, legitimacy, adoption, change of name, dissolution of 
marriage, legal separation, or declaration of invalidity of marriage that is filed in the office 
of each clerk of a court of record in this state on or after July 1, 1985. The tax shall be paid 
at the time of the filing of such action, and the clerk shall keep such tax in a separate fund 
and shall transmit such tax monthly to the state treasurer, who shall credit the same to the 
vital statistics records cash fund pursuant to section 25-2-121. A delegate child support 
enforcement unit acting pursuant to article 13 of title 26, C.R.S., shall be exempt from 
paying the tax authorized in this subsection (2). 

Source: L. 67: R&RE, p. 1058, § 1. C.R.S. 1963: § 66-8-7. L. 72: Entire section 
amended, p. 600, § 90, effective May 23. L. 78: Entire section amended, p. 269, § 80, 
effective May 23. L. 84: Entire section amended, p. 744, § 7, effective July 1. L. 85: 
Entire section amended, p. 879, § 1, effective May 24. L. 89: (2) amended, p. 796, § 28, 
effective July 1. L. 96: (1) amended, p. 614, § 19, effective July 1. 

25-2-108. Reports and certificates as to births and deaths. (Repealed) 

Source: L. 67: R&RE, p. 1058, § 1. C.R.S. 1963: § 66-8-8. L. 84: Entire section 
repealed, p. 751, § 16, effective July 1. 

25-2-109. Local registration districts for processing of birth and death certificates. 
(Repealed) 

Source: L. 67: R&RE, p. 1058, § 1. C.R.S. 1963: § 66-8-9. L. 83: (1) amended, p. 
1039, § 18, effective May 20. L. 84: Entire section repealed, p. 751, § 16, effective July 
1. 

25-2-110. Certificates of death - repeal. ( 1) (a) A certificate of death for each death, 
including a stillborn death, that occurs in Colorado must be filed with the state registrar or 
as otherwise directed by the state registrar, within five days after the death occurs and prior 
to final disposition. The state registrar shall register the certificate if it has been completed 
in accordance with this section. Every certificate of death must identify the decedent's 
social security number, if available. If the place of death is unknown but the dead body is 
found in Colorado, the certificate of death must be completed and filed in accordance with 
this section. The place where the body is found must be shown as the place of death. If the 
date of death is unknown, the date must be determined by approximation. 

(b) (I) The department of public health and environment shall create and the state 
registrar shall use an electronic death registration system for the purpose of collecting death 
information from funeral directors, coroners, physicians, local registrars, health facilities, 
and other authorized individuals, as determined by the department. Death information 
submitted electronically by a funeral director, coroner, physician, local registrar, health 
facility, or authorized individual, as determined by the department, to the electronic death 



25-2- 1 10 Health Title 25 - page 106 

registration system for purposes of fulfilling the requirements of this section satisfies the 
signature and filing requirements of this section and section 30-10-606, C.R.S. 

(II) No later than two years after August 8, 2012, the department shall report to the 
health and human services committee of the senate and the health and environment 
committee of the house of representatives, or their successor committees, on the develop- 
ment and implementation of the electronic death registration system. The department shall 
include in the report information regarding whether the department has modified staffing 
levels and fees since the implementation of the system. This subparagraph (II) is repealed, 
effective September 1, 2014. 

(2) When a death occurs in a moving conveyance in the United States and the body is 
first removed from the conveyance in Colorado, the death shall be registered in Colorado, 
and the place where it is first removed shall be considered the place of death. When a death 
occurs on a moving conveyance while in international air space or in a foreign country or 
its air space and the body is first removed from the conveyance in Colorado, the death shall 
be registered in Colorado, but the certificate shall show the actual place of death insofar as 
can be determined. 

(3) (a) The funeral director or person acting as such who first assumes custody of a 
dead body, stillborn fetus, or dead fetus shall be responsible for the filing of the death 
certificate required by subsection (1) of this section. He or she shall obtain the personal data 
required by the certificate from the next of kin or the best qualified person or source 
available. He or she shall obtain the medical certification necessary to complete the portion 
of the certificate pertaining to the cause of death from the best qualified person or source 
available, pursuant to subsection (4) of this section. 

(b) In the case of a stillborn fetus, notwithstanding the provisions of paragraph (a) of 
this subsection (3), the physician, nurse, or other medical personnel attending to the 
stillborn death may assume responsibility for filing the death certificate required by 
paragraph (a) of this subsection (3). The person filing the death certificate in the case of a 
stillborn fetus shall obtain the personal data required by the certificate from a parent and 
shall include a name on the death certificate if a parent desires to identify a name. 

(c) If a death certificate is not filed in the case of a stillborn death as required by 
paragraph (a) of this subsection (3), a parent may inform the state registrar of the 
information necessary to complete the death certificate. The state registrar shall confirm 
such information and complete the death certificate accordingly. 

(4) Except when inquiry is required by section 30-10-606, C.R.S., the physician in 
charge of the patient's care for the illness or condition that resulted in death shall complete, 
sign, and return to the funeral director or person acting as such all medical certification 
within forty-eight hours after a death occurs. In the absence of said physician or with his 
or her approval, the certificate may be completed and signed by his or her associate 
physician, by the chief medical officer of the institution in which the death occurred, or by 
the physician who performed an autopsy upon the decedent, if such individual has access 
to the medical history of the case, if he or she views the decedent at or after the time of 
death, and if the death is due to natural causes. If an autopsy is performed, the certification 
shall indicate whether the decedent was pregnant at the time of death, and said information 
shall be reported on the death certificate as required by subsection (9) of this section. 

(5) When inquiry is required by section 30-10-606, C.R.S. , the coroner shall determine 
the cause of death and shall complete and sign the medical certification within forty-eight 
hours after taking charge of the case. If an autopsy is performed, the certification shall 
indicate whether the decedent was pregnant at the time of death, and said information shall 
be reported on the death certificate as required by subsection (9) of this section. 

(6) If the cause of death cannot be determined within forty-eight hours after a death, the 
medical certification shall be completed as provided by rule. If an autopsy is performed, the 
certification shall indicate whether the decedent was pregnant at the time of death, and said 
information shall be reported on the death certificate as required by subsection (9) of this 
section. The attending physician or coroner shall give the funeral director or person acting 
as such notice of the reason for the delay, and final disposition of the body shall not be made 
until authorized by the office designated or established pursuant to section 25-2-103 in the 
county where the death occurred or, if such an office does not exist in the county where the 



Title 25 -page 107 



Vital Statistics 



25-2-110.5 



death occurred, final disposition of the body shall not be made until authorized by the 
coroner or the coroner's designee. 

(7) When a death is presumed to have occurred within Colorado but the body cannot 
be located, a death certificate may be prepared by the state registrar upon receipt of an order 
of a court of competent jurisdiction which shall include the finding of facts required to 
complete the death certificate. Such a death certificate shall be marked "presumptive" and 
shall show on its face the date of registration and shall identify the court and the date of 
decree. 

(8) Every funeral establishment shall maintain registration with the office of the state 
registrar and shall act in accordance with the provisions of this article. 

(9) (a) If an autopsy is performed, a certificate of death shall identify whether the 
decedent was pregnant at the time of death. 

(b) The requirement in this subsection (9) and subsections (4), (5), and (6) of this 
section to indicate whether the decedent was pregnant at the time of death shall be complied 
with when the person required to make the designation has access to the certification form 
that permits compliance. 

Source: L. 67: R&RE, p. 1059, § 1. C.R.S. 1963: § 66-8-10. L. 84: Entire section 
R&RE, p. 744, § 8, effective July 1. L. 97: (1) amended, p. 1286, § 29, effective July 1. 
L. 2001: (1) and (3) amended, p. 439, § 2, effective August 8. L. 2005: (9) added, p. 214, 
§ 1, effective July 1. L. 2011: (4), (5), (6), and (9) amended, (HB 11-1183), ch. 85, p. 230, 
§ 1, effective August 10. L. 2012: (1) amended, (HB 12-1041), ch. 266, p. 1384, § 1, 
effective August 8. 

Cross references: (1) For unlawful acts of funeral establishments and mortuary science pracd- 
doners, see § 12-54-117; for a certified copy of an affidavit of death as proof in joint tenancy, see 
§§ 38-31-102 and 38-31-103. 

(2) For the legisladve declaration contained in the 1997 act amending subsection (1), see section 
1 of chapter 236, Session Laws of Colorado 1997. 

ANNOTATION 



Law reviews. For article, "Sciendfic Find- 
ings on Death and Coroner's Inquest", see 20 
Rocky Mt. L. Rev. 197 (1948). 

The term "physician" relates solely to doc- 
tors of medicine and osteopathy. Colo. Chiro- 
practic Ass'n v. State, 171 Colo. 395, 467 R2d 
795 (1970). 

Death under care of chiropractor is "with- 
out medical assistance". Where one dies while 
under the care of a chiropractor, it is a "death 



occurring without medical attendance". Colo. 
Chiropractic Ass'n v. State, 171 Colo. 395, 467 
R2d795 (1970). 

Thus, a chiropractor may not sign a death 
certificate. Colo. Chiropractic Ass'n v. State, 
171 Colo. 395, 467 R2d 795 (1970). 

Article does not encompass autopsy re- 
ports. Denver Publishing Co. v. Dreyfus, 184 
Colo. 288, 520 R2d 104 (1974). 



25-2-110.5. Fetal deaths - treatment of remains. ( 1 ) In every instance of fetal death, 
the pregnant woman shall have the option of treating the remains of a fetal death pursuant 
to article 54 of title 12, C.R.S. 

(2) In every instance of fetal death, the health care provider, upon request of the 
pregnant woman, shall release to the woman or the woman's designee the remains of a fetal 
death for final disposition in accordance with applicable law. Such request shall be made by 
the pregnant woman or her authorized representative prior to or immediately following the 
expulsion or extraction of the fetal remains. Unless a timely request was made, nothing in 
this section shall require the health care provider to maintain or preserve the fetal remains. 

(3) (a) Nothing in this section shall prohibit a health care provider from conducting or 
acquiring medical tests on the remains of a fetal death prior to release. 

(b) Upon a request pursuant to subsection (2) of this section, whenever a medical test 
is conducted pursuant to paragraph (a) of this subsection (3), the health care provider 
conducting the test shall, where medically permissible and otherwise permitted by law, 



25-2- 1 1 1 Health Title 25 - page 108 

release to the pregnant woman or the woman's designee the remains of a fetal death for final 
disposition. 

(4) Nothing in this section shall prohibit the health care provider from requiring a 
release of liability for the release of the remains of a fetal death prior to such release. 

(5) A health care provider shall be immune from all civil or criminal liability, suit, or 
sanction with regard to any action taken in good faith compliance with the provisions of this 
section. 

Source: L. 2001: Entire section added, p. 1032, § 2, effective June 5. 

25-2-111. Dead bodies - disposition - removal from state - records. (1) Any person 
requested to act as funeral director for a dead body or otherwise whoever first assumes 
custody of a dead body shall, prior to final disposition of the body, obtain authorization for 
final disposition of the body. The office designated or established pursuant to section 
25-2-103 in the county where the death occurred or, if such an office does not exist in the 
county where the death occurred, the coroner or the coroner's designee shall authorize final 
disposition of the body on a form prescribed and furnished by the state registrar. No body 
shall be buried, cremated, deposited in a vault or tomb, or otherwise disposed of, nor shall 
any body be removed from this state, until such authorization has been obtained, completed, 
and approved. The coroner or the coroner's designee shall include in the authorization 
notice of the requirements of subsection (7) of this section. 

(2) A disposition permit issued under the law of another state which accompanies a 
dead body or fetus brought into this state shall be authority for final disposition of the body 
or fetus in this state. 

(3) Repealed. 

(4) Any person who removes from the place of death or transports or finally disposes 
of a dead body or fetus, in addition to filing any certificate or other form required by this 
article, shall keep a record which shall identify the body and such information pertaining to 
his receipt, removal, and delivery of such body as may be prescribed in regulations. Such 
record shall be retained for a period of not less than seven years and shall be made available 
for inspection by the state registrar or his representative upon demand. 

(5) No sexton or other person in charge of any place in which interment or other 
disposition of dead bodies is made shall inter or allow interment or other disposition of a 
dead body or fetus unless it is accompanied by authorization for final disposition. 

(6) Authorization for disinterment and reinterment shall be required prior to disinter- 
ment of a dead body or fetus. Such authorization shall be issued by the state registrar to a 
funeral director or person acting as such upon proper application. 

(7) (a) The owner of land that is used to inter a dead human body shall record the burial 
within thirty days after the burial with the county clerk and recorder of the county in which 
the land is situated. The owner shall record the following: 

(I) The dead person's name as it appears on the death certificate; 

(II) The dead person's date of birth; 

(III) The dead person's age at the time of death; 

(IV) The cause of death; 

(V) The name of the owner or owners of the property where the dead human body is 
interred; 

(VI) The legal description of the property where the dead human body is interred if the 
person is interred on private property; 

(VII) The reception number for the death certificate if recorded by the county clerk; and 

(VIII) The latitude and longitude coordinates, such as those given by a global posi- 
tioning system, that are verified by two witnesses or the county coroner, sheriff, or a 
designee of the county coroner or sheriff. 

(b) This subsection (7) does not apply to dead human bodies interred in cemeteries, 
vaults, or tombs operated or maintained by public entities or businesses that inter people in 
the ordinary course of business and are available to the general public. 



Title 25 - page 109 Vital Statistics 25-2-1 12 

Source: L. 67: R&RE, p. 1059, § 1. C.R.S. 1963: § 66-8-11. L. 84: (1) amended, (3) 
repealed, and (5) and (6) added, p. 745, 751, §§ 9, 16, effective July 1. L. 85: (1) amended, 
p. 880, § 2, effective May 24. L. 2010: (1) amended and (7) added, (HB 10-1275), ch. 193, 
p. 827, § 1, effective August 11. 

25-2-111.5. Transfer of fetal tissue from induced termination of pregnancy - 
legislative declaration. (1) The general assembly hereby finds, determines, and declares 
that the United States congress enacted 42 U.S.C. sec. 289g-2, prohibiting the acquisition, 
receipt, or other transfer of human fetal tissue for valuable consideration if the transfer 
affects interstate commerce. The general assembly determines and declares that the acqui- 
sition, receipt, or other transfer of human fetal tissue for valuable consideration affects 
intrastate commerce and is not in the public interest of the residents of Colorado. Therefore, 
the general assembly finds, determines, and declares that the exchange for valuable 
consideration of human fetal tissue should be prohibited. 

(2) (a) No physician or institution that performs procedures for the induced termination 
of pregnancy shall transfer such tissue for valuable consideration to any organization or 
person that conducts research using fetal tissue or that transplants fetal tissue for therapeutic 
purposes. For the purposes of this section, "valuable consideration" includes, but is not 
limited to: 

(1) Any lease-sharing agreement in excess of the current market value for commercial 
rental property for the area in which the physician's or institution's place of business is 
located; 

(II) Any lease-sharing agreement that is based on the term or number of induced 
terminations of pregnancy performed by such physician or institution; 

(III) Any moneys, gifts in lieu of money, barter arrangements, or exchange of services 
that do not constitute reasonable payment associated with the transportation, implantation, 
processing, preservation, quality control, or storage of human fetal tissue as defined in 42 
U.S.C. sec. 289g-2; or 

(IV) Any agreement to purchase fetal tissue for a profit. 

(b) Nothing in this subsection (2) shall prevent the disposition of fetal tissue from an 
induced termination of pregnancy pursuant to part 4 of article 15 of this title. 

(3) Any physician or institution that violates subsection (2) of this section shall be fined 
by the state registrar not more than ten thousand dollars, depending upon the severity of the 
violation. 

(4) The department of public health and environment may promulgate rules related to 
enforcement activities necessary to implement subsections (2) and (3) of this section. 

Source: L. 2000: Entire section added, p. 1073, § 2, effective August 2. 

25-2-112. Certificates of birth - filing - establishment of paternity. ( 1 ) A certificate 
of birth for each live birth which occurs in this state shall be filed with the state registrar 
or as otherwise directed by the state registrar within ten days after such birth and shall be 
registered if it has been completed and filed in accordance with this section. When a birth 
occurs on a moving conveyance within the United States and the child is first removed from 
the conveyance in Colorado, the birth shall be registered in Colorado, and the place where 
the child is first removed shall be considered the place of birth. When a birth occurs on a 
moving conveyance while in international air space or in a foreign country or its air space 
and the child is first removed from the conveyance in Colorado, the birth shall be registered 
in this state but the certificate shall show the actual place of birth insofar as can be 
determined. Either of the parents of the child shall verify the accuracy of the personal data 
entered thereon in time to permit its fifing within such ten-day period. 

(2) When a birth occurs in an institution, or upon order of any court with proper 
jurisdiction, the person in charge of the institution or such person's designated represen- 
tative shall obtain the personal data, prepare the certificate, certify the authenticity of the 
birth registration either by signature or by an approved electronic process, and file it with 
the state registrar or as otherwise directed by the state registrar within the required ten days; 



25-2- 1 1 2 Health Title 25 - page 1 1 

the physician in attendance shall provide the medical information required by the certificate 
within five days after the birth. When the birth occurs outside an institution, the certificate 
shall be prepared and filed by the physician in attendance at or immediately after birth, or 
in the absence of such a physician by any person witnessing the birth, or in the absence of 
any such witness by the father or mother, or in the absence of the father and the inability 
of the mother by the person in charge of the premises where the birth occurred. The person 
who completes and files the certificate shall also be responsible for obtaining the social 
security account numbers of the parents and delivering those numbers to the state registrar 
along with the certificate. 

(2.5) Repealed. 

(2.7) For the purposes of a birth registration, the mother is deemed to be the woman 
who has given birth to the child, unless otherwise provided by law or determined by a court 
of competent jurisdiction prior to the filing of the birth certificate. The information about the 
father shall be entered as provided in subsection (3) of this section. 

(3) (a) If the mother was married either at the time of conception or birth, the name of 
the husband shall be entered on the certificate as the father of the child unless: 

(I) Paternity has been determined otherwise by a court of competent jurisdiction, in 
which case the name of the father as so determined shall be entered; or 

(II) The mother and the mother's husband execute joint or separate forms prescribed 
and furnished by the state registrar reflecting the mother's and the husband's signatures 
individually witnessed and attesting that the husband is not the father of the child, in which 
case, information about the father shall be omitted from the certificate; or 

(III) The mother executes a form prescribed and furnished by the state registrar 
attesting that the husband is not the father and that the putative father is the father, the 
putative father executes a form prescribed and furnished by the state registrar attesting that 
he is the father, and the husband executes a form prescribed and furnished by the state 
registrar attesting that he is not the father. Such forms may be joint or individual or a 
combination thereof, and each signature shall be individually witnessed. In such event, the 
putative father shall be shown as the father on the certificate. 

(IV) A court of competent jurisdiction has determined the husband is not the presumed 
father and the putative father executes a form prescribed and furnished by the state registrar 
which is individually witnessed attesting that he is the father and the mother executes a form 
prescribed and furnished by the state registrar which is individually witnessed that the 
putative father is the father. In such event the putative father shall be shown as the father 
on the birth certificate. 

(b) If the mother was not married at the time of conception or birth, the name of the 
father shall be entered if, but only if, the mother and the person to be named as the father 
so request in writing on a form prescribed and furnished by the state registrar or if paternity 
has been determined by a court of competent jurisdiction, in which case the name of the 
father as so determined shall be entered. 

(c) For purposes of acknowledging paternity, the form prescribed and furnished by the 
state registrar shall contain the minimum requirements specified by the secretary of the 
federal department of health and human services. 

(3.5) Upon the birth of a child to an unmarried woman in an institution, the person in 
charge of the institution or that person's designated representative shall provide an 
opportunity for the child's mother and natural father to complete a written acknowledgment 
of paternity on the form prescribed and furnished by the state registrar. 

(4) Whoever assumes the custody of a living infant of unknown parentage shall report 
on a form and in the manner prescribed by the state registrar within ten days to the state 
registrar or as otherwise directed by the state registrar such information as the state registrar 
shall require, which report shall constitute the certificate of birth for the infant. The place 
where the child was found shall be entered as the place of birth, and the date of birth shall 
be determined by approximation. If the child is identified and a certificate of birth is found 
or obtained, any report registered under this section shall be sealed and filed and, except as 
provided in section 25-2-113.5, may be opened only by order of a court of competent 
jurisdiction or as provided by regulation. 

(5) and (6) (Deleted by amendment, L. 93, p. 952, § 1, effective September 1, 1993.) 



Title 25 - page 111 Vital Statistics 25-2-112.5 

Source: L. 67: R&RE, p. 1059, § 1. C.R.S. 1963: § 66-8-12. L. 83: (4) amended, p. 
1047, § 2, effective June 15. L. 84: Entire section amended, p. 746, § 10, effective July 
1. L. 90: (2) amended and (5) and (6) added, p. 900, § 29, effective July 1. L. 93: (2.5) 
added, p. 1921, § 6, effective July 1; (1), (2), (3), (5), and (6) amended and (2.7) and (3.5) 
added, p. 952, § 1, effective September 1. L. 94: (3)(a) amended, p. 1543, § 18, effective 
May 31; (3)(a)(II), (3)(a)(III), (3)(a)(IV), and (3.5) amended, pp. 2044, 2045, §§ 1, 2, 
effective June 3. L. 96: (2.5) amended, p. 402, § 14, effective April 17. L. 97: (3)(c) 
added, p. 1286, § 30, effective July 1. 

Editor's note: (1) Amendments to subsection (3)(a) by Senate Bill 94-088 and Senate Bill 
94-141 were harmonized. 

(2) Subsection (2.5)(b) provided for the repeal of section (2.5) effective July 1, 2001. (See L. 96, 
p. 402.) 

Cross references: (1) For statement in the certificate as to whether blood test for syphilis has 
been made, see § 25-4-203; for penalty for failure to file a certificate, see § 25-2-118. 

(2) For the legislative declaration contained in the 1997 act enacting subsection (3)(c), see section 
1 of chapter 236, Session Laws of Colorado 1997. 

ANNOTATION 

Effect of failure to file within time specified Manship v. People, 99 Colo. 1, 58 P.2d 1215 

in this section is to subject the doctor to a fine or (1936) (concurring opinion), 
imprisonment under § 25-2-118. Manship v. AppUed in People in Interest of an Unborn 

People, 99 Colo. 1, 58 P2d 1215 (1936) (con- Child v. Estergard, 169 Colo. 445, 457 P2d 698 

curring opinion). (1969). 

But it does not affect the admissibility of a 
copy of the certificate certified by the registrar. 

25-2-112.3. Certificates of stillbirth - filing - delayed registration - rules. (1) The 

state registrar shall create a certificate of stillbirth and shall furnish and distribute such form 
as necessary. The state board of health shall promulgate rules necessary to implement this 
section. 

(2) (a) A certificate of stillbirth shall be offered to a mother after the occurrence of any 
stillbirth. If the mother decides to have a certificate of stillbirth filed, it shall be filed with 
the state registrar within three days after the stillbirth occurs and shall be registered by the 
state registrar if it has been completed and filed in accordance with the provisions of this 
section and section 25-2-112. 

(b) If the mother decides not to place a name on the certificate of stillbirth, the person 
preparing the certificate of stillbirth shall leave this option on the certificate blank. 

(3) Notwithstanding the provisions set forth in subsection (2) of this section, if a 
certificate of stillbirth is not registered after one year from the date the stillbirth occurs, a 
certificate marked "Delayed" may be filed and registered in accordance with the provisions 
of section 25-2-114. 

Source: L. 2004: Entire section added, p. 473, § 2, effective July 1. 

25-2-112.5. Social security account numbers - acknowledgments of paternity - to 
be furnished. (1) Regardless of the marital status of the mother, each parent shall furnish 
the social security account number or numbers, if the parent has more than one such 
number, issued to that parent, and the other parent's social security account number, if 
known, at the time of the child's birth to the person authorized under section 25-2-112 to 
obtain them for the state registrar, unless the state, in accordance with federal regulations, 
finds good cause for not requiring the parent to furnish such numbers to the state. 

(2) The department of public health and environment shall make the birth certificate, 
the mother's and father's social security account numbers, and any written acknowledg- 
ments of paternity, including any notarized affidavits acknowledging paternity and any 
witnessed forms prescribed and furnished by the state registrar, furnished under this section 



25-2- 1 1 3 Health Title 25 - page 1 1 2 

and section 25-2-112 available to the state agency responsible for enforcing child support 
under Title IV-D of the federal "Social Security Act" upon request of that agency. The 
social security account numbers shall not be recorded on the birth certificate and may not 
be used for any purpose other than for the establishment and enforcement of child support 
orders. 

Source: L. 93: Entire section added, p. 954, § 2, effective September 1. L. 94: (2) 

amended, p. 2045, § 3, effective June 3; (2) amended, p. 2748, § 399, effective July 1. 

Editor's note: Amendments to subsection (2) by Senate Bill 94-141 and House Bill 94-1029 were 
harmonized. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-2-113. New certificates of birth following adoption - legitimation - parentage 
determination. ( 1 ) (a) A new certificate of birth shall be prepared by the state registrar 
as to any person bom in this state whenever he receives with respect to such a person any 
of the following: A report concerning adoption, legitimacy, or parentage as required by 
section 25-2-107; or a report or certified copy of a decree concerning the adoption, 
legitimacy, or parentage of such a person from a court of competent jurisdiction outside this 
state; or a certified copy of the marriage certificate of the parents, together with a statement 
of the husband, executed after such marriage, in which the husband acknowledges paternity; 
but with respect to adoptions no new certificate of birth shall be prepared if the state 
registrar is requested not to do so by the court that has decreed the adoption, by an adoptive 
parent, or by the adopted person. Each new certificate shall show all information shown on 
the original certificate of birth, except information for which substitute information is 
included as a result of the report or decree which prompts the preparation of the new 
certificate. 

(b) A new certificate of birth shall be prepared by the state registrar as to any adopted 
person born in a foreign country and a resident of this state whenever the state registrar 
receives with respect to such person a certified copy of the final decree of adoption as 
required by section 19-5-212, C.R.S., and section 25-2-107 and findings of fact as required 
by this section. In proceedings for the adoption of a person who was born in a foreign 
country, the juvenile court having jurisdiction of adoptions, upon evidence from reliable 
sources, shall make findings of fact as to the date and place of birth and parentage of such 
person. The state registrar shall prepare a new birth certificate in the new name of the 
adopted person and shall seal the certified copy of the findings of the court and the certified 
copy of the final decree of adoption which shall be kept confidential except as otherwise 
provided in part 3 of article 5 of title 19, C.R.S. The birth certificate shall be labeled as a 
certificate of foreign birth and shall show specifically the true or probable country of birth 
and that the certificate is not evidence of United States citizenship. If the child was bom in 
a foreign country but was a citizen of the United States at the time of birth, the state registrar 
shall not prepare a certificate of foreign birth but instead shall notify the adoptive parents 
of the procedures for obtaining a revised birth certificate for their child through the United 
States department of state. Any copy of a certificate of foreign birth issued shall indicate this 
policy, show the actual place of birth, and indicate the fact that the certificate is not proof 
of United States citizenship for the adopted child. A new certificate of birth in the new name 
of the adopted person prepared by the state registrar pursuant to this section is hereby 
legalized and made valid. 

(c) Repealed. 

(2) (a) The state registrar shall register each new certificate of birth prepared pursuant 
to subsection (1) of this section by marking thereon the words "new certificate", by 
marking thereon the date such certificate is completed, which date thereafter shall be the 
registration date, and by substituting such new certificate for the original certificate of birth 
for such person. 



Title 25 - page 113 Vital Statistics 25-2-113.5 

(b) A new certificate of birth issued pursuant to an adoption, and any copy of such 
certificate issued, shall be marked by the state registrar with the words "issued pursuant to 
adoption" if so requested by an adoptive parent or by an adopted person. 

(c) The state registrar shall develop rules to ensure that the adoptive parent's decision 
to include such information, in paragraph (b) of this subsection (2), is made knowingly, 
including having a separate signature line verifying such choice. 

(3) Thereafter, the original certificate and evidence concerning adoption, legitimacy, or 
parentage shall be sealed and not be subject to inspection except as provided in section 
25-2-1 13.5 or in part 3 of article 5 of title 19, C.R.S., by regulation, or upon order of a court 
of competent jurisdiction after the court has satisfied itself that the interests of the child or 
the child's descendants or the parents will best be served by opening said seal. The 
information obtained from opening said seal may be withheld from public view or from 
being presented as evidence at the discretion of the judge. 

(4) In the event the decree which formed the basis for the new certificate of birth is 
annulled and if the state registrar receives either a certified copy of such decree of 
annulment or a report with respect to such decree as required by section 25-2-107, the state 
registrar shall return the original certificate to its place in the files. Thereafter the new 
certificate and evidence concerning the annulment shall not be subject to inspection except 
as provided in section 25-2-113.5, upon order of a court of competent jurisdiction, or as 
provided by regulation. 

(5) If no certificate of birth is on file for the person for whom a new birth certificate is 
to be established under this section and the date and place of birth have not been determined 
in the adoption or paternity proceedings, a delayed certificate of birth shall be filed with the 
state registrar before a new certificate of birth is established. The new birth certificate shall 
be prepared on the delayed birth certificate form. 

(6) When a new certificate of birth is established by the state registrar, all copies of the 
original certificate of birth in the custody of any other custodian of vital records in this state 
shall be sealed from inspection, except as otherwise provided in part 3 of article 5 of title 
19, C.R.S., or forwarded to the state registrar, as the state registrar shall direct. 

Source: L. 67: R&RE, p. 1060, § 1. C.R.S. 1963: § 66-8-13. L. 76: (1) amended, p. 
651, § 1, effective July 1. L. 78: (l)(a) and (3) amended, p. 269, § 81, effective May 23. 
L. 83: (3) and (4) amended, p. 1047, § 3, effective June 15. L. 84: (l)(b) amended, (l)(c) 
repealed, and (5) and (6) added, pp. 747, 751, §§ 11, 16, effective July 1. L. 87: (l)(b) 
amended, p. 820, § 35, effective October 1. L. 99: (l)(b), (3), and (6) amended, p. 1136, 
§ 5, effective July 1. L. 2002: (2) amended, p. 333, § 1, effective August 7. 

ANNOTATION 

Law reviews. For article, "The Adoption of 
Children in Colorado", see 37 Dicta 100 (1960). 

25-2-113.5. Limited access to information upon consent of all parties - voluntary 
adoption registry. ( 1 ) Adoption is based upon the legal termination of parental rights and 
responsibilities of birth parents and the creation of the legal relationship of parent and child 
between an adoptee and his or her adoptive parents. Under current laws and the social 
premises underlying adoption, the general assembly has been charged with the duty to 
preserve the right to privacy and confidentiality of birth parents whose children were 
adopted, the adoptees, and the adoptive parents. The general assembly recognizes, however, 
that some adults who were adopted as children, their siblings who may or may not have 
been adopted, and some birth parents whose children were surrendered for adoption have 
a strong desire to obtain information about each other. The purpose of this section is to set 
up a voluntary adoption registry where qualified persons may register their wiUingness to 
the release of information to each other and to provide for the disclosure of such 
information. 

(2) As used in this section, unless the context otherwise requires: 



25-2-113.5 Health Title 25 - page 114 

(a) "Adoptive parent" means an adult who has become a parent of a child through the 
legal process of adoption. 

(b) "Consent" means a verified written statement which has been notarized. 

(c) "Identifying information" includes the following information: 

(I) The name of the qualified adoptee before placement in adoption; 

(II) The name and address of each qualified birth parent as it appears in birth records; 

(III) The current name, address, and telephone number of the qualified adult adoptee; 
and 

(IV) The current name, address, and telephone number of each qualified birth parent. 

(d) "Qualified adult adoptee" means an adopted person eighteen years of age or older 
who was bom in Colorado and who meets the requirements of this section. 

(e) "Qualified birth parent" means a genetic, biological, or natural parent whose rights 
were voluntarily or involuntarily terminated by a court or otherwise and who meets the 
requirements of this section. "Birth parent" includes a man who is the parent of a child as 
established in accordance with the provisions of the "Uniform Parentage Act", article 4 of 
title 19, C.R.S., prior to the termination of parental rights and who meets the requirements 
of this section. 

(f) "Registrar" means the state registrar of vital statistics or his designated represen- 
tative. 

(g) "Relative" includes an individual's spouse, birth parent, adoptive parent, sibling, or 
child who is twenty-one years of age or older. 

(g.5) "Sibhng" shall have the same meaning as "biological sibHng", section 19-1-103 
(14), C.R.S. 

(h) "Voluntary adoption registry" or "registry" means a place where eligible persons, 
as described in this section, may indicate their willingness to have their identities and 
whereabouts disclosed to each other under conditions specified in this section. 

(3) The registrar shall maintain a confidential list of qualified adult adoptees who have 
presented a consent regarding the release of identifying information about themselves. Any 
consent by a qualified adult adoptee shall be accompanied by the adoptee's desired method 
of notification in the event that a match occurs; however, the state shall not incur costs of 
notification in excess of that part of the fee charged to the applicant for the purpose of 
notification. Any consent shall also indicate whether the qualified adult adoptee desires 
release of his identifying information if a match occurs after his death. The qualified adult 
adoptee may revise his consent with respect to change of address or method of notification. 
Any name and accompanying information shall be removed from the list upon the verified 
written request of the listed adoptee. The registrar shall maintain a closed record of such list 
and accompanying information, except as provided in accordance with this section. 

(4) The registrar shall maintain a confidential list of qualified birth parents who have 
presented a consent regarding the release of identifying information about themselves. Any 
consent by a qualified birth parent shall be accompanied by the birth parent's desired 
method of notification in the event that a match occurs; however, the state shall not incur 
costs of notification in excess of that part of the fee charged to the applicant for the purpose 
of notification. Any consent shall also indicate whether the qualified birth parent desires 
release of his identifying information if a match occurs after his death. The qualified birth 
parent may revise his consent with respect to change of address or method of notification. 
Any name and accompanying information shall be removed from the list upon the verified 
written request of the listed birth parent. The registrar shall maintain a closed record of such 
list and accompanying information, except as provided in accordance with this section. Any 
birth parent who in terminating his parental rights used an alias, and this alias is listed in 
the original sealed birth certificate, may also file a consent with the registry. A birth parent 
shall not be matched with the qualified adult adoptee without the consent of the other birth 
parent unless: 

(a) There is only one birth parent listed on the birth certificate; or 

(b) The other birth parent is deceased; or 

(c) The other birth parent is unable to be located by the department of public health and 
environment after an exhaustive search, the cost of said search to be fully funded by the 



Title 25 - page 115 Vital Statistics 25-2-113.5 

birth parent seeking a match, said search to be in accordance with the rules and regulations 
promulgated by the department. 

(5) The registrar shall maintain a confidential list of relatives of deceased qualified 
adult adoptees and relatives of deceased qualified birth parents who have presented a 
consent regarding the release of identifying information about themselves. Any consent by 
such relative shall be accompanied by the person's desired method of notification in the 
event that a match occurs; however, the state shall not incur costs of notification in excess 
of that part of the fee charged to the applicant for the purpose of notification. Such relative 
may revise his consent with respect to change of address or method of notification. Any 
name and accompanying information shall be removed from the list upon the verified 
written request of the listed relative. The registrar shall maintain a closed record of such list 
and accompanying information, except as provided in accordance with this section. 

(5.5) The registrar shall maintain a confidential list of former foster children who may 
or may not have been adopted, who are eighteen years of age or older, who have presented 
a consent regarding the release of identifying information about themselves and who are 
searching for a sibling who is also eighteen years of age or older, who may or may not have 
been adopted, and who may or may not have been in the foster care system. Any consent 
by such sibling shall be accompanied by the sibling's desired method of notification in the 
event that a match occurs. However, the state shall not incur costs of notification in excess 
of that part of the fee charged to the applicant for the purpose of notification. A sibling may 
revise his or her consent with respect to change of address or method of notification. Any 
name and accompanying information shall be removed from the list upon the verified 
written request of the listed sibling. The registrar shall maintain a closed record of the list 
and accompanying information except as provided for pursuant to this section. 

(6) The registrar shall regularly review the lists provided for in subsections (3), (4), (5), 
and (5.5) of this section and any other nonsealed administrative files or records within his 
or her office to determine if there is a match. If it appears that a match has occurred, then 
and only then is the registrar authorized to proceed to confirm the match through recourse 
to sealed documents on file in the office of the registrar. When a match is confirmed, the 
registrar shall notify each party, by his or her designated method only, prior to an exchange 
of identifying information. Nothing in this section shall be construed to allow any state or 
local governmental department, agency, or institution, or any employee thereof, to solicit 
any consent for the release of identifying information. 

(7) Nothing in this section shall be construed to allow the registrar to issue a copy of 
the original birth certificate to any registrant. 

(8) Any person who knowingly uses, publishes, or divulges information obtained 
through operation of the registry to any person in a manner not authorized by this section 
commits a class 2 petty offense and, upon conviction thereof, shall be punished by a fine 
of five hundred dollars. 

(9) Notwithstanding any other provision of law, the information acquired by the 
registry shall not be disclosed under any public records law, sunshine or freedom of 
information legislation, rules, or practice. 

(10) (a) The executive director of the department of public health and environment 
shall establish fees to be charged each person requesting that his name be placed on the list 
provided for in subsection (3), (4), or (5) of this section and for the services provided by the 
registrar in establishing and implementing the registry pursuant to this section. It is the 
intent of the general assembly that the fees shall cover all direct and indirect costs incurred 
pursuant to this section. 

(b) The fees collected pursuant to this section shall be transmitted to the state treasurer, 
who shall credit the same to the general fund. The general assembly shall annually 
appropriate from the general fund to the department of public health and environment an 
amount sufficient to meet expenses incurred pursuant to this section. 

Source: L. 83: Entire section added, p. 1044, § 1, effective June 15. L. 87: (2)(e) 
amended, p. 821, § 36, effective October 1. L. 94: (4)(c), (10)(a), and (10)(b) amended, p. 
2748, § 400, effective July 1. L. 2005: (2)(d) amended, p. 993, § 7, effective July 1. 
L. 2009: (1) and (6) amended and (2)(g.5) and (5.5) added, (SB 09-079), ch. 59, pp. 214, 
215, §§ 2, 3, effective March 25. 



25-2- 1 14 Health Title 25 - page 116 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(4)(c), (10)(a), and (10)(b), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-2-114. Delayed registration of births and deaths. (1) When a birth, foundling 
birth, death, or fetal death has occurred in this state but no certificate as to such event has 
been filed or registered in accordance with the provisions of section 25-2-110 or 25-2-112, 
a certificate as to such event may be accepted for filing or registration, or both, in 
accordance with applicable regulations concerning certificates that have not been timely or 
properly filed or registered. The state registrar shall endorse on the certificate a summary 
statement of the evidence submitted to substantiate the facts asserted in such certificate. If 
a certificate is not registered until more than a year after the event, the state registrar shall 
mark the word "Delayed" on the face thereof. 

(2) When the state registrar finds the certificate or such supplementary evidence as may 
be required by regulations to be deficient or invalid, the certificate shall not be registered, 
and the person who requested the registration shall be advised in writing both as to the basis 
for the alleged deficiency or invalidity and also as to such person's right of appeal. Judicial 
review of the action of the state registrar may be had in accordance with the provisions of 
section 24-4-106, C.R.S., but an action for judicial review shall be commenced within sixty 
days after the date the state registrar gives his notice in writing of his decision. If no action 
for judicial review is commenced within said period, the state registrar shall return the 
certificate and all documents submitted in support thereof to the person submitting the same 
if registration of the certificate has been refused. 

Source: L. 67: R&RE, p. 1061, § 1. C.R.S. 1963: § 66-8-14. 

25-2-115. Alteration of reports and certificates - amended reports and certificates. 

(1) No vital statistics report or certificate shall ever be altered in any way except in 
accordance with this article and applicable regulations. The date of alteration and a 
summary description of the evidence submitted in support of the alteration shall be 
endorsed on or made a part of each vital statistics certificate that is altered. Every vital 
statistics report or certificate that is altered in any way shall be marked "Amended" except 
the birth report or certificate of any illegitimate child altered by the addition of a father's 
name pursuant to section 25-2-112 (3), in which case, upon request of the parents, the 
surname of the child shall be changed on the report and certificate to that of the father, and 
also except additions and minor corrections made within one year after the date of the 
statistical event as may be specified by applicable regulations. A child's surname may be 
changed upon affidavit of the parent that the change is being made to conform such child's 
surname to the parent's legal surname. 

(2) Upon receipt of a certified copy of a court order changing the name of a person bom 
in this state and upon request of such person, or upon the request of his parent, guardian, 
or legal representative if he is under a legal disability, the original certificate of birth shall 
be amended to reflect the new name thereon. 

(3) In the event the state registrar alters a birth certificate or death certificate, he shall 
promptly report the amendment to any other custodians of the vital statistics record and 
their records shall be amended accordingly. 

(4) Upon receipt of a certified copy of an order of a court of competent jurisdiction 
indicating that the sex of an individual bom in this state has been changed by surgical 
procedure and that such individual's name has been changed, the certificate of birth of such 
individual shall be amended as prescribed by regulation. 

(5) When an applicant does not submit the minimum documentation required in the 
regulations for amending a vital statistics record or when the state registrar has reasonable 
cause to question the validity or adequacy of the applicant's swom statements or docu- 
mentary evidence, and if the deficiencies are not corrected, the state registrar shall not 
amend the vital statistics record and shall advise the applicant of the reason for this action 
and shall further advise the applicant of the right of appeal to a court of competent 
jurisdiction. 



Title 25 - page 1 17 Vital Statistics 25-2-1 17 

Source: L. 67: R&RE, p. 1061, § 1. C.R.S. 1963: § 66-8-15. L. 77: (1) amended, p. 
1274, § 1, effective May 20. L. 84: (3) amended and (4) and (5) added, p. 748, § 12, 
effective July 1. 

25-2-116. Institutions to keep records - persons to furnish information. (1 ) Every 
person in charge of an institution shall keep a record of personal particulars and dates 
concerning each person admitted or confined to such institution. This record shall include 
such information as required by the standard certificate of birth, death, and fetal death forms 
issued under the provisions of this article. The record shall be made at the time of 
admission. The name and address of the person providing the information shall appear on 
the record. 

(2) When a dead human body is released or disposed of by an institution, the person in 
charge of the institution shall record the name of the deceased, date of death, name and 
address of the person to whom the body is released, and date of removal from the 
institution, or, if finally disposed of by the institution, the date, place, and manner of 
disposition shall be recorded. 

(3) Any person having knowledge of the facts shall furnish such information as he may 
possess regarding any birth, death, fetal death, adoption, marriage, or dissolution of 
marriage upon demand of the state registrar. 

Source: L. 67: R&RE, p. 1062, § 1. C.R.S. 1963: § 66-8-16. 

25-2-117. Certified copies furnished - fee. (1) Vital statistics records shall be treated 
as confidential, but the department of public health and environment shall, upon request, 
furnish to any applicant having a direct and tangible interest in a vital statistics record a 
certified copy of any record registered under the provisions of this article. Any copy of the 
record of a birth or death, when properly certified by the state registrar or as otherwise 
directed by the state registrar to be a true copy thereof, shall be prima facie evidence in all 
courts and places of the facts therein stated. 

(2) An appHcant shall pay fees estabHshed pursuant to section 25-2-121 for each of the 
following services: 

(a) The reproduction and certification of birth or death records; except that an applicant 
shall not pay a fee: 

(I) For the provision of a certified copy of such a record to: 

(A) Another state agency; 

(B) A county department of social services or human services; or 

(C) An individual presenting a letter of referral from a county department of social 
services; or 

(II) If the applicant is a delegate child support enforcement unit acting pursuant to 
article 13 of title 26, C.R.S.; 

(b) Any search of the files and records of the state registrar when no certified copy is 
made, such fee to pertain to each hour or fractional hour of time of the search; 

(c) The processing of new certificates, delayed certificates, or corrected certificates; 

(d) The verification of marriage or divorce; and 

(e) The reproduction of various vital statistics, publications, reports, and data services. 

(3) To preserve vital statistics records, the state registrar is authorized to prepare 
typewritten, photographic, electronic, or other reproductions of certificates or reports. When 
certified by the state registrar, such reproductions shall be accepted as the original records. 
The documents from which permanent reproductions have been made and verified may be 
disposed of as provided by regulation. 

Source: L. 67: R&RE, p. 1062, § 1. C.R.S. 1963: § 66-8-17. L. 82: Entire section 
amended, p. 408, § 1, effective July 1. L. 83: Entire section amended, p. 1049, § 1, 
effective June 15. L. 84: Entire section amended, p. 749, § 13, effective July 1. L. 89: 



25-2-117 



Health 



Title 25 -page 118 



(2)(a) amended, p. 796, § 29, effective July 1. L. 94: (1) amended, p. 2749, § 401, 
effective July 1. L. 2010: (2)(a) amended, (SB 10-006), ch. 341, p. 1578, § 2, effective 
June 5. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in 
the 2010 act amending subsection (2)(a), see section 1 of chapter 341, Session Laws of Colorado 
2010. 

ANNOTATION 



I. General Consideration. 
II. Confidentiality. 
III. Certified Copy as Evidence. 

L GENERAL CONSIDERATION. 

Law reviews. For article, "Hearsay in Crim- 
inal Cases Under the Colorado Rules of Evi- 
dence: An Overview", see 50 U. Colo. L. Rev. 
277 (1979). 

II. CONFIDENTIALITY. 

Records exempt from public record act's 
right to inspect. This section exempts vital 
statistics records from right to inspect given by 
public records act and person is entitled to cop- 
ies of such records only if he can show direct 
and tangible interest. Eugene Cervi & Co. v. 
Russell, 31 Colo. App. 525, 506 R2d 748 
(1972), affd, 184 Colo. 282, 519 R2d 1189 
(1974). 

Provisions for record search not authority 
to provide copy. The provisions of this section 
providing for a search of the records by their 
custodian do not authorize the custodian to pro- 
vide a copy of the record or to divulge the 
contents. Purpose of such search is to determine 
whether a particular record exists, and informa- 
tion contained in such record can only be re- 
leased to those having prescribed interest. Eu- 
gene Cervi & Co. v. Russell, 31 Colo. App. 525, 
506 R2d 748 (1972), affd, 184 Colo. 282, 519 
R2d 1189 (1974). 

Registrar of vital statistics has limited dis- 
cretion. The registrar of vital statistics is a 
ministerial officer who, unlike a judge, has but 
limited discretion in the performance of his du- 
ties. Eugene Cervi & Co. v. Russell, 184 Colo. 
282, 519 R2d 1189(1974). 

The discretion of the registrar of vital statis- 
tics is limited to furnishing the information to an 
"applicant having a direct and tangible inter- 
est", and, where the petitioner does not have the 
requisite "significant legal relationship", then 
the registrar does not have discretion to furnish 
the information. Eugene Cervi & Co. v. Russell, 
184 Colo. 282, 519 R2d 1189 (1974). 

"Applicant having direct and tangible in- 
terest" is one who has significant legal relation- 
ship to person who is subject of record. Eugene 



Cervi & Co. v Russell, 31 Colo. App. 525, 506 
R2d 748 (1972), affd, 184 Colo. 282, 519 R2d 
1189(1974). 

Person seeking copies of vital statistics re- 
cord for commercial purposes does not have 
the direct and tangible interest required by this 
section. Eugene Cervi & Co. v. Russell, 31 Colo. 
App. 525, 506 R2d 748 (1972), affd, 184 Colo. 
282, 519 R2d 1189 (1974). 

III. CERTIFIED COPY AS EVIDENCE. 

Dependability of certification by local reg- 
istrar. A birth certificate certified by the local 
registrar is as dependable as one certified by the 
state registrar, since it is the former who fur- 
nishes the information to the latter. Trujillo v. 
People, 122 Colo. 436, 222 P2d 775 (1950). 

Copy is prima facie evidence. A certified 
copy of a death certificate is admissible and is 
prima facie evidence of the facts recited therein. 
Parfet v Kansas City Life Ins. Co., 128 F2d 361 
(10th Cir.), cert, denied, 317 U.S. 654, 63 S. Ct. 
50, 87 L.Ed. 526 (1942); Occidental Life Ins. 
Co. V United States Nat'l Bank, 98 Colo. 126, 
53 R2d 1180 (1935); Indus. Comm'n v Havens, 
136 Colo. Ill, 314 R2d 698 (1957); Michael v 
John Hancock Mut. Life Ins. Co., 138 Colo. 
450, 334 P2d 1090 (1959); Nat'l Farmers Union 
Life Ins. Co. v Norwood, 147 Colo. 283, 363 
R2d 681 (1961); City & County of Denver v 
Smerdel, 165 Colo. 475, 440 R2d 158 (1968); 
Robinson v. New York Life Ins. Co., 30 Colo. 
App. 83, 490 P2d 81 (1971); Lockwood v 
Travelers Ins. Co., 179 Colo. 103, 498 R2d 947 
(1972). 

However, the weight of the certified copy of 
a death certificate depends upon the informa- 
tion upon which it is based, the source of that 
information, and the manner in which it is ob- 
tained. Prudential Ins. Co. v. Cline, 98 Colo. 
275, 57 R2d 1205 (1935); Nat'l Farmers Union 
Life Ins. Co. v Norwood, 147 Colo. 283, 363 
P2d 681 (1961); City & County of Denver v 
Smerdel, 165 Colo. 475, 440 R2d 158 (1968); 
Robinson v. New York Life Ins. Co., 30 Colo. 
App. 83, 490 P2d 81 (1971); Lockwood v 
Travelers Ins. Co., 179 Colo. 103, 498 P2d 947 
(1972); Simonton v Continental Cas. Co., 32 
Colo. App. 138, 507 P2d 1132 (1973). 



Title 25 - page 1 1 9 Vital Statistics 25-2- 1 20 

Limitation where issue is cause of death. Coroner's conclusive statement should be 

The term "facts" as used in this section does not excised. Therefore, it is error to introduce a 
extend to the coroner's opinion as to whether coroner's death certificate statement without ex- 
death from external means resulted from acci- cision of the conclusive statement that death 
dent, suicide, or homicide, when the critical resulted by accident rather than by suicide or 
issue in the case is whether death resulted from homicide. Lockwood v. Travelers Ins. Co., 179 
one of these causes. Lockwood v. Travelers Ins. Colo 103 498 P2d 947 (1972) 
Co., 179 Colo. 103, 498 P.2d 947 (1972). 

25-2-118. Penalties. (1) Any person who knowingly and willfully makes any false 
statement in or supplies any false information for or for purposes of deception applies for, 
alters, mutilates, uses, attempts to use, applies for amendments thereto, or furnishes to 
another for deceptive use any vital statistics certificate, and any person who knowingly and 
willfully and for purposes of deception uses or attempts to use or furnishes for use by 
another any vital statistics certificate knowing that such certificate contains false informa- 
tion or relates to a person other than the person with respect to whom it purports to relate, 
and any person who manufactures, advertises for sale, sells, or alters any vital statistics 
certificate knowing or having reason to know that such document establishes or may be 
used to establish a false status, occupation, membership, license, privilege, or identity for 
himself or any other person, and any person who uses any such document to commit a crime 
is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not 
more than one thousand dollars, or by imprisonment in the county jail for not more than one 
year, or by both such fine and imprisonment. 

(2) Any person who willfully violates any of the provisions of this article or refuses or 
neglects to perform any of the duties imposed upon him by this article is guilty of a 
misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than one 
hundred dollars, or by imprisonment in the county jail for not more than thirty days, or by 
both such fine and imprisonment. 

Source: L. 67: R&RE, p. 1062, § 1. C.R.S. 1963: § 66-8-18. L. 84: (1) amended, p. 
750, § 14, effective July 1. 

ANNOTATION 

Malice must be proved. Where an under- ing the former to be sufficient, he is guilty of no 

taker was issued a permit to remove a body, but misdemeanor in the absence of malice, 

sought no burial permit from any registrar of Addington v. Bates, 101 Colo. 293, 73 P.2d 529 

vital statistics prior to interment of body, believ- ( 1 937). 

25-2-119. Tax on court action affecting vital statistics. (Repealed) 

Source: L. 67: R&RE, p. 1063, § 1. C.R.S. 1963: § 66-8-19. L. 78: Entire section 
amended, p. 270, § 82, effective May 23. L. 84: Entire section repealed, p. 751, § 16, 
effective July 1. 

25-2-120. Reports of electroconvulsive treatment. (1) Any person who performs 
electroconvulsive treatment in the state of Colorado shall file a report with the department 
of public health and environment setting forth the data required by subsection (2) of this 
section. An institution in which electroconvulsive treatment is performed shall be the 
reporting entity for all electroconvulsive treatments performed at that institution. 

(2) Such reports shall be made to the department of public health and environment on 
forms prescribed by the department within thirty days after January 1 and July 1 of each 
year on a semiannual basis and shall contain the following detailed information for each 
reporting period: 

(a) The total number, broken down by inpatient and outpatient and exclusive of 
substance abuse, of adult psychiatric admissions, minor children psychiatric admissions, 
and readmissions of both; 



25-2-121 Health Title 25 - page 120 

(b) The number of patients within each category of paragraph (a) of this subsection (2) 
who received electroconvulsive treatment; 

(c) Statistical information on each patient receiving electroconvulsive treatment includ- 
ing, but not limited to, the following: 

(1) Diagnosis; 

(II) Number of electroconvulsive treatments; 
(HI) Age; 

(IV) Sex; 

(V) Ethnicity; 

(VI) Whether such patient was voluntary or involuntary; 

(VII) Whether or not such patient was capable of giving his written informed consent; 

(VIII) Whether or not any complications resulted from such electroconvulsive treat- 
ment, such as cardiac arrest, fracture, apnea, memory loss, or death (including autopsy 
results with particular attention to the brain); 

(IX) The method of payment for such electroconvulsive treatment and, if applicable, 
the name of the insurance company making such payments. 

(3) The name of the patient receiving electroconvulsive treatment shall remain confi- 
dential information and shall not be disclosed to the department, any other agency or 
individual. The forms prescribed by subsection (2) of this section shall not require any 
information which would disclose, directly or indirectly, the identity of the patient. 

Source: L. 79: Entire section added, p. 613, § 2, effective June 22. L. 94: (1) and IP(2) 
amended, p. 2749, § 402, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection (1) 
and the introductory portion to subsection (2), see section 1 of chapter 345, Session Laws of Colorado 
1994. 

25-2-121. Fee adjustments - vital statistics records cash fund created. (1) This 
section shall apply to all activities of the office of the state registrar in the department of 
public health and environment. 

(2) (a) The office of the state registrar shall propose, as part of its annual budget 
request, an adjustment in the amount of each fee that the office of the state registrar is 
authorized by law to collect. The budget request and the adjusted fees for the office of the 
state registrar shall reflect its direct and indirect costs and the direct and indirect costs 
necessary to maintain and operate the Colorado responds to children with special needs 
program. 

(b) (I) Based upon the appropriation made and subject to the approval of the executive 
director of the department of public health and environment, the office of the state registrar 
shall adjust its fees so that the revenue generated from said fees approximates its direct and 
indirect costs and the direct and indirect costs necessary to maintain and operate the 
Colorado responds to children with special needs program. Such fees shall remain in effect 
for the fiscal year for which the budget request applies. All fees collected by the office of 
the state registrar shall be transmitted to the state treasurer, who shall credit the same to the 
vital statistics records cash fund, which fund is hereby created. All moneys credited to the 
vital statistics records cash fund and all interest earned thereon shall be subject to 
appropriation by the general assembly to be used as provided in this section and shall not 
be deposited in or transferred to the general fund of this state or any other fund. 

(II) For those services required by this article and those services provided by the 
Colorado responds to children with special needs program, each office designated or 
established pursuant to section 25-2-103 shall charge fees as specified by the state registrar. 
Such fees shall be used for the purpose of paying the direct and indirect costs of the office 
and the office of the state registrar for compliance with the provisions of this article and the 
direct and indirect costs necessary to maintain and operate the Colorado responds to 
children with special needs program. 

(c) Beginning July 1, 1985, and each July 1 thereafter, whenever moneys appropriated 
to the office of the state registrar for its activities for the prior fiscal year are unexpended, 



Title 25 - page 121 Vital Statistics 25-2-122 

said moneys shall be made a part of the appropriation to the office of the state registrar for 
the next fiscal year, and such amount shall not be raised from fees collected by the office 
of the state registrar. If a supplemental appropriation is made to the office of the state 
registrar for its activities and the services provided by the Colorado responds to children 
with special needs program, the fees of the office of the state registrar, when adjusted for 
the fiscal year following that in which the supplemental appropriation was made, shall be 
adjusted by an additional amount that is sufficient to compensate for the supplemental 
appropriation. Moneys appropriated to the office of the state registrar in the annual general 
appropriation act shall be designated as cash funds and shall not exceed the amount 
anticipated to be raised from fees collected by the office of the state registrar. 

(d) For purposes of this section, "Colorado responds to children with special needs 
program" means the program established within the department of public health and 
environment under the authority of section 25-1.5-105. 

(3) Notwithstanding any provision of subsection (2) of this section to the contrary, on 
March 5, 2003, the state treasurer shall deduct seven hundred sixty-three thousand six 
hundred eighty dollars from the vital statistics records cash fund and transfer such sum to 
the general fund. 

Source: L. 84: Entire section added, p. 750, § 15, effective July 1. L. 94: (1) and 
(2)(b)(I) amended, p. 2750, § 403, effective July 1. L. 2003: (3) added, p. 458, § 18, 
effective March 5. L. 2008: (2) amended, p. 2065, § 1, effective June 3. L. 2010: 
(2)(b)(II) amended, (SB 10-006), ch. 341, p. 1578, § 3, effective June 5. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(1) and (2)(b)(I), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative 
declaration in the 2010 act amending subsection (2)(b)(II), see section 1 of chapter 341, Session Laws 
of Colorado 2010. 

25-2-122. Heirloom birth and marriage certificates - funds created - report - rules 
- definitions. (1) As used in this section, unless the context otherwise requires: 

(a) "Heirloom birth certificate" means a birth certificate that is suitable for display and 
may bear the seal of the state and be signed by the governor. 

(b) "Heirloom marriage certificate" means a marriage certificate that is suitable for 
display and may bear the seal of the state and be signed by the governor. 

(2) (a) In addition to any other birth certificate issued pursuant to section 25-2-1 12, the 
state registrar shall issue, upon request and upon payment of a fee established by rule of the 
state board of health, an heirloom birth certificate representing the birth of the individual 
named on the original birth certificate. The state registrar may establish procedures for 
issuing heirloom birth certificates; except that an heirloom birth certificate shall be issued 
in a form consistent with the need to protect the integrity of vital records, including secure 
measures designed to prevent tampering, counterfeiting, or otherwise duplicating the birth 
certificate for fraudulent purposes, pursuant to the federal "Intelligence Reform and 
Terrorism Prevention Act of 2004", 5 U.S.C. sec. 301. 

(b) An heirloom birth certificate shall have the same status as evidence as that of an 
original birth certificate. 

(c) The fee established pursuant to paragraph (a) of this subsection (2) shall be 
sufficient to cover the direct and indirect costs of producing and issuing the heirloom birth 
certificate, plus an additional ten dollars. The state registrar shall transmit moneys generated 
pursuant to this subsection (2), along with an explanation of the number of heirloom birth 
certificate sales that correspond to such moneys, to the state treasurer, who shall credit: 

(I) For each sale of an heirloom birth certificate, ten dollars to the immunization fund 
created in section 25-4-1708; and 

(II) The remainder of such moneys to the vital statistics records cash fund created in 
section 25-2-121. 

(3) (a) In addition to any other marriage certificate issued pursuant to section 25-2-106, 
the state registrar shall issue, upon request and upon payment of a fee established by rule 
of the state board of health, an heirloom marriage certificate representing the marriage of 



25-2-122 



Health 



Title 25 - page 122 



the persons named on the original marriage certificate recorded in the county clerk and 
recorder's office. The state registrar may establish procedures for issuing the heirloom 
marriage certificates; except that an heirloom marriage certificate shall be issued in a form 
consistent with the need to protect the integrity of vital records. 

(b) An heirloom marriage certificate shall have the same status as evidence as that of 
an original marriage certificate. 

(c) The fee established pursuant to paragraph (a) of this subsection (3) shall be 
sufficient to cover the direct and indirect costs of producing and issuing the heirloom 
marriage certificate, plus an additional ten dollars. The state registrar shall transmit moneys 
generated pursuant to this subsection (3), along with an explanation of the number of 
heirloom marriage certificate sales that correspond to such moneys, to the state treasurer, 
who shall credit: 

(I) For each sale of an heirloom marriage certificate, ten dollars to the Colorado 
domestic abuse program fund created in section 39-22-802, C.R.S.; and 

(II) The remainder of such moneys to the vital statistics records cash fund created in 
section 25-2-121. 



Source: L. 2006: Entire section added, p. 943, 
(2)(c)(I) amended, p. 654, § 1, effective April 26. 



§ 1, effective August 7. L. 2007: 



HOSPITALS 

ARTICLE 3 
Hospitals 

Cross references: For the university of Colorado university hospital and the university of Colorado 
psychiatric hospital, see articles 21 and 22 of title 23; for the Colorado mental health institute at 
Pueblo, see article 93 of title 27; for hospital districts, see §§ 32-1-1001 and 32-1-1003. 



PART 1 
HOSPITALS 

25-3-100.5. Definitions. 

25-3-101. Hospitals - health facilities - li- 

censed - definitions. 

25-3-102. License - application - issuance 

- certificate of compliance re- 
quired. 

25-3-102.1. Deemed status for certain facil- 
ities. 

25-3-102.5. Nursing facilities - consumer 
satisfaction survey - pilot 
survey. 

25-3-103. License denial or revocation - 

provisional license - rules. 

25-3-103.1. Health facilities general licen- 
sure cash fund. 

25-3-103.5. Nondiscrimination - hospital 
surgical privileges - hospital 
rules and regulafions. 

25-3-103.7. Employment of physicians - 
when permissible - condi- 
dons - definitions. 

25-3-104. Reports. 

25-3-105. License - fee - rules - penalty. 

25-3-106. Unincorporated associations. 

25-3-107. Disciplinary acfions reported to 



Colorado medical board or 

podiatry board. 
25-3-108. Receivership. 

25-3-109. Quality management functions 

- confidentiality and immu- 
nity. 

25-3-110. Emergency contraception 

definifions. 
25-3- HI. Authentication of verbal orders 

- hospital policies or bylaws. 
25-3-112. Hospitals - charges for the un- 
insured - collections protec- 
tion - charity care informa- 
tion. 

25-3-113. Health care facility stakeholder 

forum - Creadon - member- 
ship - duties. 

PART 2 

MATERNITY HOSPITALS 

25-3-201 to 

25-3-207. (Repealed) 

PART 3 

COUNTY HOSPITALS - ESTABLISHMENT 



25-3-301. 



Establishment of public hospi- 
tal. 



Title 25 -page 123 



Hospitals 



25-3-101 



25-3-302. Board of trustees. 

25-3-303. Organization of trustees. 

25-3-304. Trustees - powers and duties. 

25-3-305. Vacancies - removal for cause. 

25-3-306. Right of eminent domain. 

25-3-307. Building requirements. 

25-3-308. Improvements or enlargements. 

25-3-309. Hospital fees. 

25-3-310. Rules and regulations. 

25-3-311. Donations permitted. 

25-3-312. Training school for nurses. 

25-3-313. Lease of hospital. 

25-3-314. Charge for professional ser- 
vices. 

25-3-315. Records of hospital. 

PART 4 

STATE PLAN FOR IMPLEMENTATION 

OF FEDERAL ACT FOR THE 

CONSTRUCTION OF HEALTH 

FACILITIES 



25-3-401. 
25-3-402. 



25-3-403. 



Department to administer plan. 

State advisory hospital and 
mental retardation facilities 
and community mental 
health centers council. (Re- 
pealed) 

Department to administer fed- 
eral mental retardation and 
mental health construction 
funds. 



PART 5 
CERTIFICATE OF PUBLIC NECESSITY 



25-3-501 to 
25-3-521. 



(Repealed) 
PART 6 



HOSPITAL-ACQUIRED INFECTIONS 
DISCLOSURE 



25-3-601. 


Definitions. 


25-3-602. 


Health facility reports 


25-3-603. 


Department reports. 


25-3-604. 


Privacy. 


25-3-605. 


Confidentiality. 


25-3-606. 


Penalties. 


25-3-607. 


Regulatory oversight. 



repeal. 



PART 7 

COLORADO HOSPITAL REPORT CARD 
ACT 



25-3-701. 
25-3-702. 



25-3-703. 
25-3-704. 
25-3-705. 



Short title. 

Comprehensive hospital infor- 
mation system - executive di- 
rector - duties - definitions. 

Hospital report card. 

Fees. 

Health care charge transpar- 
ency - hospital charge report. 



PART 1 
HOSPITALS 

25-3-100.5. Definitions. As used in this article, unless the context otherwise requires: 
(1) "Acute treatment unit" means a facility or a distinct part of a facility for short-term 
psychiatric care, which may include substance abuse treatment, that provides a total, 
twenty-four-hour, therapeutically planned and professionally staffed environment for per- 
sons who do not require inpatient hospitalization but need more intense and individual 
services than are available on an outpatient basis, such as crisis management and stabili- 
zation services. 

Source: L. 2006: Entire section added, p. 1391, § 22, effective August 7. 



25-3-101. Hospitals - health facilities - licensed - definitions. (1) It is unlawful for 
any person, partnership, association, or corporation to open, conduct, or maintain any 
general hospital, hospital unit, psychiatric hospital, community clinic, rehabilitation hos- 
pital, convalescent center, community mental health center, acute treatment unit, facility for 
persons with developmental disabilities, as defined in section 25-1.5-103 (2) (c), nursing 
care facility, hospice care, assisted living residence, except an assisted living residence shall 
be assessed a license fee as set forth in section 25-27-107, dialysis treatment clinic, 
ambulatory surgical center, birthing center, home care agency, or other facility of a like 
nature, except those wholly owned and operated by any governmental unit or agency, 
without first having obtained a license from the department of public health and environ- 
ment. 

(2) As used in this section, unless the context otherwise requires: 



25-3-101 Health Title 25 - page 124 

(a) (I) "Community clinic" means a health care facility that provides health care 
services on an ambulatory basis, is neither licensed as an on-campus department or service 
of a hospital nor listed as an off-campus location under a hospital's license, and meets at 
least one of the following criteria: 

(A) Operates inpatient beds at the facility for the provision of extended observation and 
other related services for not more than seventy-two hours; 

(B) Provides emergency services at the facility; or 

(C) Is not otherwise subject to health facility licensure under this section or section 
25-1.5-103 but opts to obtain licensure as a community clinic in order to receive private 
donations, grants, government funds, or other public or private reimbursement for services 
rendered. 

(II) "Community clinic" includes a prison clinic operated by the department of 
corrections. 

(III) "Community cUnic" does not include: 

(A) A federally qualified health center, as defined in section 1861 (aa) (4) of the federal 
"Social Security Act", 42 U.S.C. sec. 1395x (aa) (4); 

(B) A rural health clinic, as defined in section 1861 (aa) (2) of the federal "Social 
Security Act", 42 U.S.C. sec. 1395x (aa) (2); 

(C) A facility that functions only as an office for the practice of medicine or the delivery 
of primary care services by other licensed or certified practitioners. 

(b) "Hospital unit" means a physical portion of a licensed or certified general hospital, 
psychiatric hospital, maternity hospital, or rehabilitation hospital that is leased or otherwise 
occupied pursuant to a contractual agreement by a person other than the licensee of the host 
facility for the purpose of providing outpatient or inpatient services. 

(3) Nothing in this section shall be construed to require the licensing of individual 
services provided by a licensed or certified provider on its own premises. 

(4) A health care facility is not required to be licensed as a community clinic solely due 
to the facility's ownership status, corporate structure, or engagement of outside vendors to 
perform nonclinical management services. This section permits regulation of a physician's 
office only to the extent the office is a community clinic as defined in this section. 

Source: L. 09: p. 411, § 1. C.L. § 1053. CSA: C. 78, § 133. CRS 53: § 66-4-1. 
C.R.S. 1963: § 66-4-1. L. 71: p. 631, § 1. L. 78: Entire section amended, p. 440, § 3, 
effective May 18. L. 83: Entire section amended, p. 1051, § 1, effective May 25. L. 84: 
(1) amended, p. 338, § 4, effective April 25. L. 94: (1) amended, p. 2750, § 404, effective 
July 1. L. 95: Entire section amended, p. 1023, § 2, effective July 1. L. 2002: (1) 
amended, p. 1329, § 16, effective July 1. L. 2006: (1) amended, p. 1391, § 23, effective 
August 7. L. 2008: (1) amended, p. 2233, § 2, effective August 5. L. 2011: (1) and (2) 
amended, (HB 11-1101), ch. 94, p. 277, § 2, effective April 8; (2)(a) amended, (HB 
11-1323), ch. 265, p. 1198, § 2, effective June 2. L. 2012: (1) and (2)(a) amended and (4) 
added, (HB 12-1294), ch. 252, p. 1253, § 3, effective June 4. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in 
the 2012 act amending subsections (1) and (2)(a) and adding subsection (4), see secfion 1 of chapter 
252, Session Laws of Colorado 2012. 

ANNOTATION 

Law reviews. For comment on Moon v. Mercy Hosp., 150 Colo. 430, 373 P.2d 944 

Mercy Hosp., appearing below, see 35 U. Colo. (1962). 

L. Rev. 612 (1963). For article, "Smith v. Hospitals and doctors require different li- 
O'Halloran: Nursing Home Reform in the censes. This secfion and § 12-36-107 are ex- 
Courts", see 13 Colo. Law. 2248 (1984). pressions of the legislafive will that hospitals 

Hospital license is prerequisite. A license to and doctors require different licenses. These li- 

operate a hospital is a prerequisite to the func- censes authorize related but different activities, 

tioning of such an establishment. Moon v. and the issuance of the one does not permit 



Title 25 - page 125 



Hospitals 



25-3-102 



operation under the other. The general assembly 
plainly and unequivocally has treated these pur- 
suits as separate and distinct pursuits requiring 
different licenses. Purcell v. Poor Sisters of St. 
Francis Seraph, 147 Colo. 478, 364 P.2d 184 
(1961); Moon v. Mercy Hosp., 150 Colo. 430, 
373 R2d 944 (1962). 

Licensed hospital covered by malpractice 
limitations section. A hospital which is licensed 
under this section is clearly embraced within 
provisions of § 13-80-105 (now § 13-80-102 
(l)(c)) prohibiting the bringing of an action to 
recover from a "licensed health establishment" 
due to alleged negligence unless such action be 



instituted within two years after the cause ac- 
crued. Adams v. Poudre Valley Hosp. Dist., 173 
Colo. 98, 476R2d565 (1970). 

Licensing by home-rule city. The provisions 
of this article do not conflict with any rights of 
a home-rule city as to the licensing of a chiro- 
practic sanitarium since the general assembly 
can provide for the licensing of hospitals within 
the limits of home-rule cities in the interest of 
general health. Spears Free Clinic & Hosp. for 
Poor Children v. State Bd. of Health, 122 Colo. 
147, 220R2d872 (1950). 

Applied in In re Estate of Smith v. 
O'Halloran, 557 R Supp. 289 (D. Colo. 1983). 



25-3-102. License - application - issuance - certificate of compliance required. 

(1) (a) An applicant for a license described in section 25-3-101 shall apply to the 
department of public health and environment annually upon such form and in such manner 
as prescribed by the department; except that a community residential home shall make 
application for a license pursuant to section 27-10.5-109, C.R.S. 

(b) The department has authority to administer oaths, subpoena witnesses or docu- 
ments, and take testimony in all matters relating to issuing, denying, limiting, suspending, 
or revoking a license. 

(c) The department shall issue licenses to applicants furnishing satisfactory evidence of 
fitness to conduct and maintain a health facility described in section 25-3-101 in accordance 
with this part 1 and the rules adopted by the department. The department shall not require, 
as satisfactory evidence of fitness, evidence as to whether an applicant has provided self 
declarations, affidavits, or other attestations as to its general compliance with statutory or 
regulatory licensing requirements. The department shall determine an applicant's fitness 
solely based on the specific fitness information or documentation submitted by the applicant 
upon the department' s request or as otherwise acquired by the department through its own 
review or investigation of the applicant. The department may require the applicant to attest 
to the accuracy of the information provided as long as the attestation does not require the 
applicant's affirmation of its general compliance with statutory or regulatory licensing 
requirements. 

(d) The license shall be signed by the president and attested by the secretary of the state 
board of health and have the state board's seal affixed to the license. The license expires one 
year from the date of issuance. 

(e) (I) For a change of ownership, the department shall conduct a fitness review of a 
new owner based upon information compiled within the five years preceding the date of the 
application; except that the new owner shall disclose whether, within the ten years 
preceding the date of an application, the new owner: 

(A) Has been convicted of a felony or misdemeanor involving moral turpitude; 

(B) Had a state license or federal certification denied, revoked, or suspended by another 
jurisdiction; 

(C) Had a civil judgment or criminal conviction against the new owner in a case 
brought by the federal, state, or local authorities that resulted from the operation, manage- 
ment, or ownership of a health facility or other entity related to substandard patient care or 
health care fraud. 

(II) The new owner shall provide the information specified in subparagraph (I) of this 
paragraph (e) to the department regardless of whether action has been stayed during a 
judicial appeal or otherwise settled between the parties. 

(III) The department may review an existing owner of a licensed health facility or entity 
only when the department has new information not previously available or disclosed that 
bears on the fitness of the existing owner to operate or maintain a licensed health facility 
or entity. 

(IV) A conversion of the health facility's or entity's legal structure, or the legal 
structure of an entity that has a direct or indirect ownership interest in the health facility or 



25-3-102.1 Health Title 25 - page 126 

entity, is not a change of ownership unless the conversion also includes a transfer of at least 
fifty percent of the licensed facility's direct or indirect ownership interest to one or more 
new owners. 

(2) In the hcensing of a community mental health center, acute treatment unit, or clinic, 
satisfactory evidence that the applicant is in compliance with the standards, rules, and 
regulations promulgated pursuant to section 27-66-102, C.R.S., shall be required for 
licensure. 

(3) (a) Notwithstanding any provision of law to the contrary, the department of public 
health and environment shall not issue or renew any license described in section 25-3-101 
for a facility covered by section 25-1.5-103 (5) unless the department receives a certificate 
of compliance for the applicant's building or structure from the division of fire prevention 
and control in the office of preparedness, security, and fire safety within the department of 
pubhc safety in accordance with part 12 of article 33.5 of title 24, C.R.S. 

(b) The department of public health and environment shall take action on an application 
for licensure within thirty days after the date that the department receives from the applicant 
all of the necessary information and documentation required for licensure, including a 
certificate of compliance from the division of fire prevention and control. 

Editor's note: Subsection (3) is effective July 1, 2013, only if the revisor of statutes receives 
nofification. (See the editor's note following the section.) 

Source: L. 09: p. 412, § 2. C.L. § 1054. CSA: C. 78, § 134. C.R.S. 53: § 66-4-2. 
C.R.S. 1963: § 66-4-2. L. 71: p. 631, § 2. L. 79: Entire section amended, p. 1094, § 3, 
effective July 1. L. 94: (1) amended, p. 2750, § 405, effective July 1. L. 95: (1) amended, 
p. 1023, § 3, effective July 1. L. 2006: (2) amended, p. 1391, § 24, effective August 7. 
L. 2010: (2) amended, (SB 10-175), ch. 188, p. 799, § 61, effective April 29. L. 2012: (1) 
amended, (HB 12-1294), ch. 252, p. 1254, § 4, effective June 4; (1) amended and (3) added, 
(HB 12-1268), ch. 234, p. 1025, § 2, effective July 1, 2013. 

Editor's note: (1) Amendments to subsection (1) by House Bill 12-1268 and House 12-1294 
were harmonized, effective July 1, 2013. 

(2) Section 15 of chapter 234, Session Laws of Colorado 2012, provides that the amendments to 
subsections (1) and (3) by said chapter (HB 12-1268) are effecfive July 1, 2013, only if the division 
of fire prevention and control in the department of public safety notifies the revisor of statutes in 
writing, by June 30, 2013, that the secretary of the United States department of health and human 
services has granted a modification to the agreement entered into between said secretary and the state 
of Colorado pursuant to secdon 1864 of the federal "Social Security Act", 42 U.S.C. sec. 1395aa, 
which modification allows said division to fulfill the duties under that law associated with the 
assessment of compliance with the federal fire safety code requirements for health facilities. 

Cross references: For the legislative declaration contained in the 1994 act amending subsecdon 
(1), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaradon in 
the 2012 act amending subsection (1), see section 1 of chapter 252, Session Laws of Colorado 2012. 

ANNOTATION 

Relicensing and recertification. The court of Applied in Spears Free Clinic & Hosp. for 

appeals cannot order the department of health to Poor Children v. State Bd. of Health, 122 Colo, 
recertify or relicense a nursing facility for this 147, 220 P.2d 872 (1950). 
decision is statutorily committed to the depart- 
ment of health. State Dept. of Health v. Geriat- 
rics, 699 P.2d 952 (Colo. 1985). 

25-3-102.1. Deemed status for certain facilities. (1) (a) In the hcensing of an 
ambulatory surgical center following the issuance of initial licensure by the department of 
public health and environment, the voluntary submission of satisfactory evidence that the 
applicant is accredited by the joint commission, the American association for accreditation 
of ambulatory surgery facilities, inc., the accreditation association for ambulatory health 
care, the American osteopathic association, or any successor entities shall be deemed to 



Title 25 - page 1 27 Hospitals 25-3- 1 02.5 

meet certain requirements for license renewal so long as the standards for accreditation 
applied by the accrediting organization are at least as stringent as the licensure requirements 
otherwise specified by the department. 

(b) (I) In the application for the renewal of a license for a health facility described in 
section 25-3-101, other than an ambulatory surgical center, the department of public health 
and environment shall deem health facilities that are currently accredited by an accrediting 
organization recognized by the federal centers for medicare and medicaid services as 
satisfying the requirements for renewal of the license. 

(II) If the standards for national accreditation are less stringent than the state's licensure 
standards for a particular health facility, the department of public health and environment 
may conduct a survey that focuses on the more stringent state standards. Beginning one year 
after the department first grants deemed status to a health facility pursuant to this paragraph 
(b), the department may conduct validation surveys, based on a valid sample methodology, 
of up to ten percent of the total number of accredited health facilities in the industry, 
excluding hospitals. If the department conducts a validation survey of a health facility, the 
validation survey is in lieu of a licensing renewal survey that the health facility would have 
undergone if the health facility did not have deemed status pursuant to this paragraph (b). 

(III) If the department of public health and environment takes an enforcement activity, 
as defined in section 25-1.5-103 (2) (b.5), against a health facility to which it has granted 
deemed status pursuant to this paragraph (b), the department may revoke the health 
facility's deemed status. 

(c) Upon submission of a completed application for license renewal, the department of 
public health and environment shall accept proof of the accreditation in lieu of licensing 
inspections or other requirements. Nothing in this section exempts an accredited health 
facility from inspections or from other forms of oversight by the department as necessary 
to ensure public health and safety. 

(2) In determining fees otherwise payable by a health facility for license renewal, the 
department of public health and environment shall give due consideration to efficiencies and 
savings generated in connection with the deemed status process in subsection (1) of this 
section and shall specifically provide an appropriate credit or reduced fee to a health facility 
that achieves license renewal through deemed status. 

Source: L. 2008: Entire section added, p. 1236, § 1, effective August 5. L. 2009: (1) 
amended, (SB 09-292), ch. 369, p. 1970, § 84, effective August 5. L. 2012: Entire section 
amended, (HB 12-1294), ch. 252, p. 1255, § 5, effective June 4. 

Cross references: For the legislaUve declaration in the 2012 act amending this section, see section 
1 of chapter 252, Session Laws of Colorado 2012. 

25-3-102.5. Nursing facilities - consumer satisfaction survey - pilot survey. 

(1) (a) The department shall develop and implement a consumer satisfaction survey 
based on the results of the pilot survey implemented pursuant to paragraph (a.5) of this 
subsection (1). The pilot survey and the resulting consumer satisfaction survey shall be 
implemented to determine the level of satisfaction among residents and residents' families 
regarding the quality of care and quality of living in nursing facilities. "Nursing facility", 
as used in this section, means a nursing facility as defined in section 25.5-4-103 (14), C.R.S. 
The department shall appoint an advisory committee to develop the consumer satisfaction 
survey. The advisory committee shall include, but not be limited to, the state ombudsman, 
representatives of senior groups, representatives of the disabled community, representatives 
of providers of long term care services, and long term care consumers or their family 
members. The advisory committee shall develop recommendations for the development of 
an assessment tool for the consumer satisfaction survey and shall develop recommendations 
for the implementation of the pilot survey and the consumer satisfaction survey. The 
advisory committee shall ensure that a representative sample of participants are chosen and 
surveyed in a manner that will yield accurate and useful results. The department shall ensure 
that every nursing facility licensed by the department participates in the assessment of 
consumer satisfaction; except that any nursing facility that accepts exclusively private pay 



25-3-102.5 Health Title 25 - page 128 

residents shall not be required to participate. Information about results of the most recent 
consumer satisfaction survey and how such survey was conducted shall be included by the 
facility in all informational materials provided to persons who inquire about the facility. The 
department shall assure confidentiality for residents during the survey process. The depart- 
ment shall make the results of consumer satisfaction surveys available to the public. 

(a.5) (I) The department shall develop and implement a pilot consumer satisfaction 
survey to aid in the determination of the level of satisfaction among residents and residents' 
families regarding the quality of care and quality of living in nursing facilities. The pilot 
survey shall be used exclusively for the development of the consumer satisfaction survey to 
be implemented pursuant to paragraph (d) of this subsection (1) and shall not be used to 
penalize any participating facility. The pilot survey shall be used to assess: 

(A) The validity of the questionnaire for use in the consumer satisfaction survey 
implemented pursuant to paragraph (d) of this subsection (1); 

(B) The nursing facilities residents' cognition levels in order to determine the ability of 
the residents to complete the survey in a meaningful manner; 

(C) The techniques employed to obtain the number of completed survey questionnaires 
needed to achieve a statistical validity of plus or minus ten percent on the final consumer 
satisfaction survey; and 

(D) The survey data to ensure that such data is meaningful to consumers. 

(II) The pilot survey shall involve the participation of no more than ten percent of all 
nursing facilities licensed by the department. The department shall select nursing faciUties 
to participate in the pilot survey based on characteristics including, but not limited to, the 
rural or urban location of the facilities, and the cross-section of the resident population of 
the facilities. Facilities that volunteer to participate in the pilot survey shall be given priority 
in the selection process so long as the required characteristics are met. 

(III) (A) The individual nursing facility results of the pilot survey shall be confidential 
and not made available to the public; except that each nursing facility shall be provided with 
the pilot survey results from its own facility. 

(B) Aggregate statistical results of the pilot survey may be made available to the public. 

(C) Repealed. 

(IV) Repealed. 

(b) The consumer satisfaction survey shall be easy to understand so that each resident 
or resident's family member or representative who participates may fill out the survey 
unassisted; except that the department or its designated representative may assist a resident 
or resident's family with filling out the survey. Nursing facility volunteers and employees 
shall be prohibited from assisting participants with the completion of the survey. The names 
of the participants in the survey shall be kept confidential, and all surveys shall be returned 
directly to the department. 

(c) Repealed. 

(d) The department shall administer the consumer satisfaction survey based on the 
recommendations of the advisory committee in all licensed nursing facilities that are 
required to participate in accordance with paragraph (a) of this subsection (1). The 
department shall commence implementation of the survey on or before July 1, 2003. After 
the pilot survey is complete, the department shall evaluate the effectiveness of the pilot 
survey instruments, adopt any recommendations, and continue to survey all licensed 
facilities on a three-year cycle with one-third of the participating licensed nursing facilities 
completing the initial survey in one of the three years. Each participating licensed nursing 
facility shall perform a new consumer satisfaction survey every three years thereafter; 
except that the department may require, or a participating licensed nursing facility may 
request, that a new consumer satisfaction survey be performed more often if conditions 
warrant. If the licensed nursing facility requests such a survey, the department shall perform 
the survey if the licensed nursing facility pays the department for the costs associated with 
performing the survey. A licensed nursing facility may comment on the results of a 
consumer satisfaction survey and have such comments included in any publication or 
distribution of the results by the department. 



Title 25 - page 129 Hospitals 25-3-103 

(e) Hospice residents and their family members and transitional care unit residents and 
their family members, shall be exempt from participation in the pilot survey and consumer 
satisfaction survey conducted in each nursing facility. 

(f) Nursing facilities shall release the name, address, and telephone number of each 
family member or party responsible for a nursing facility resident to the department for the 
sole use of conducting the pilot survey and the consumer satisfaction survey. 

(2) (a) The department shall respond to a complaint from a nursing facility resident or 
resident's family member or representative within five working days after receipt of the 
complaint and, for sixty days after the date the department received the complaint, the 
department shall update the complainant on the status of the complaint investigation at least 
every fourteen days until the complaint is resolved and an investigation is finalized. If the 
complaint is not resolved within sixty days after the date the department received the 
complaint, the department shall continue to update the complainant on the status of the 
complaint every thirty days until the complaint is resolved and an investigation report is 
resolved and an investigation is finalized. At the request of the complainant, the department 
shall not maintain such contact. 

(b) (I) The state and local long-term care ombudsman, established pursuant to article 
11.5 of title 26, C.R.S., in compUance with the federal "Older Americans Act of 1965", 
("ombudsman") shall refer to the state department for investigation and resolution all 
complaints received by the ombudsman involving possible licensure violations in nursing 
homes that are exclusively private pay facilities. 

(II) Information about the ombudsman, including the ombudsman's role in dealing with 
resident complaints and all contact information and telephone numbers for the ombudsman, 
shall be included in the information provided to a resident upon admission to a facility that 
is not a private pay facility. 

Source: L. 2001: Entire section added, p. 1222, § 1, effective June 5. L. 2002: (l)(a) 
and (l)(d) amended and (l)(a.5), (l)(e), and (l)(f) added, p. 1924, § 1, effective June 7; 
(l)(a.5)(III)(C) repealed, p. 1935, § 4, effective July 1. L. 2004: (l)(c) repealed, p. 471, 
§ 1, effective August 4. L. 2005: (l)(a.5)(IV) repealed, p. 279, § 12, effective August 8. 
L. 2006: (l)(a) amended, p. 2014, § 87, effective July 1. 

25-3-103. License denial or revocation - provisional license - rules. (1) (a) The 

department of public health and environment may deny an application for a new or renewal 
license under this part 1 or revoke a license if the applicant or licensee has not satisfied the 
requirements of this part 1 or part 6 of this article and the rules of the department or the state 
board of health. If a license is denied or revoked, the department may grant the applicant 
or Ucensee a provisional license upon payment of a fee established by the state board of 
health by rule, subject to the limitations in paragraph (c) of this subsection (1). The 
provisional license is valid for no longer than ninety days and may be issued to allow the 
applicant or licensee time to comply with the requirements for a regular license. A second 
provisional license may be issued if the department determines it is necessary to effect 
compliance. The second provisional Hcense must be issued for the same duration as the first 
provisional license upon payment of the fee established by the state board of health by rule, 
subject to the limitations in paragraph (c) of this subsection (1). No further provisional 
licenses may be issued for the then current year after the second issuance. 

(b) The state board of health by rule or as otherwise provided by law may reduce the 
amount of the fee established pursuant to paragraph (a) of this subsection (1) if necessary 
pursuant to section 24-75-402 (3), C.R.S., to reduce the uncommitted reserves of the fund 
to which all or any portion of the fee is credited. After the uncommitted reserves of the fund 
are sufficiently reduced, the state board of health by rule or as otherwise provided by law 
may increase the amount of the fee as provided in section 24-75-402 (4), C.R.S. 

(c) On or after June 4, 2012, the state board of health may increase the amount of a 
provisional license fee established pursuant to paragraph (a) of this subsection (1) that is in 
effect on June 4, 2012, by an amount not to exceed the annual percentage change in the 
United States department of labor, bureau of labor statistics, consumer price index for 
Denver-Boulder-Greeley for all urban consumers, all goods, or its successor index. Nothing 



25-3-103.1 Health Title 25 - page 130 

in this paragraph (c) limits the ability of the state board of health to reduce the amount of 
a provisional license fee in effect on such date or to modify fees in accordance with 
paragraph (b) of this subsection (1) as necessary to comply with section 24-75-402, C.R.S. 

(2) Upon a finding of reasonable compliance by an applicant holding a provisional 
license, a regular license shall be issued upon receipt of the regular license fee established 
pursuant to section 25-3-105. 

(3) No denial of a renewal license shall be lawful unless, before institution of such 
proceedings by the department of public health and environment, said department has given 
the licensee notice in writing of facts on conduct that may warrant denial, has afforded the 
applicant opportunity to submit written data, views, and arguments with respect to such 
facts on conduct, and, except in cases of deliberate and willful violation, has given the 
applicant a reasonable opportunity to comply with all lawful requirements for licensure. 

(4) No application for renewal of a license shall be denied by the department of public 
health and environment, and no previously issued license shall be revoked, suspended, 
annulled, limited, or modified until after a hearing as provided in section 24-4-105, C.R.S. 

(5) The department of public health and environment may suspend or revoke the 
license for the operation of a nursing care facility or intermediate care facility of any 
licensee convicted of violating any provision of section 26-1-127 or section 25.5-6-206 (8), 
C.R.S., if the department finds such suspension or revocation necessary to safeguard the 
rights of patients in the future. No license or permit shall thereafter be issued to any person 
so convicted, except upon a specific finding by the department that the rights of the patients 
will have adequate safeguards. 

Source: L. 09: p. 412, § 3. C.L. § 1055. CSA: C. 78, § 135. CRS 53: § 66-4-3. 
C.R.S. 1963: § 66-4-3. L. 71: p. 632, § 3. L. 77: (5) added, p. 1357, § 5, effective June 
19. L. 78: (5) amended, p. 270, § 83, effective May 23. L. 84: (2) amended, p. 1121, § 25, 
effective June 7. L. 91: (5) amended, p. 1856, § 14, effective April 11. L. 94: (1), (3), (4), 
and (5) amended, p. 2751, § 406, effective July 1. L. 95: (1) and (2) amended, p. 1024, 
§ 4, effective July 1. L. 98: (1) and (2) amended, p. 1333, § 44, effective June 1. L. 2006: 
(l)(a) amended, p. 1574, § 2, effective June 2;(5) amended, p. 2015, § 88, effective July 
1. L. 2007: (1) amended, p. 954, § 3, effective May 17. L. 2012: (l)(a) amended and 
(l)(c) added, (HB 12-1294) ch. 252, p. 1256, § 6, effective June 4. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(1), (3), (4), and (5), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative 
declaration in the 2012 act amending subsection (l)(a) and adding subsection (l)(c), see section 1 of 
chapter 252, Session Laws of Colorado 2012. 

ANNOTATION 

Law reviews. For article, "Smith v. 147, 220 P.2d 872 (1950); In re Estate of Smith 
O'Halloran: Nursing Home Reform in the v. G'Halloran, 557 F. Supp. 289 (D. Colo. 
Courts", see 13 Colo. Law. 2248 (1984). 1983). 

Applied in Spears Free Clinic & Hosp. for 
Poor Children v. State Bd. of Health, 122 Colo. 

25-3-103.1. Health facilities general licensure cash fund. (1) All fees collected 
pursuant to this article shall be transmitted to the state treasurer, who shall credit the same 
to the health facilities general licensure cash fund, which fund is hereby created. 

(2) The general assembly shall make annual appropriations from the health facilities 
general licensure cash fund to partially reimburse the department of public health and 
environment for the direct and indirect costs of the department incurred in the performance 
of its duties under this article and for the purposes of section 25-1.5-103 (3.5). No 
appropriation shall be made out of the cash fund for expenditures incurred by the 
department pursuant to section 25-1.5-103 (1) (a) (II) in carrying out duties relating to 
health facilities wholly owned and operated by a governmental unit or agency. 



Title 25 - page 131 Hospitals 25-3-103.5 

Source: L. 95: Entire section added, p. 1024, § 5, effective July 1. L. 2003: (2) 
amended, p. 709, § 37, effective July 1. L. 2008: (2) amended, p. 1948, § 2, effective June 

2. 

25-3-103.5. Nondiscrimination - hospital surgical privileges - hospital rules and 
regulations. (1) The bylaws of any hospital licensed pursuant to the provisions of part 3 
of this article or established pursuant to section 32-1-1003, C.R.S., which does not limit 
staff privileges to employees or contracting physicians of such hospital, shall include 
provisions for the use of the facility by, and staff privileges for, duly licensed doctors of 
medicine, osteopathy, dentistry, and podiatry within the scope of their respective licenses. 
Such bylaws shall not discriminate on the basis of the staff member' s holding a degree of 
doctor of medicine, doctor of osteopathy, doctor of dental science, or doctor of podiatric 
medicine within the scope of their respective licensure. Provision shall be made in the 
bylaws for the right to pursue and practice full surgical privileges for holders of a degree 
of doctor of medicine, doctor of osteopathy, doctor of dental science, or doctor of podiatric 
medicine within the scope of their respective licensure. Such rights and privileges may be 
limited or restricted upon the basis of an individual practitioner's demonstrated training, 
experience, current competence, professional ethics, health status, or failure to abide by the 
hospital's rules, regulations, and procedures. 

(2) Nothing in this section shall be construed to require a hospital to offer a specific 
service or services not otherwise offered or to buy, construct, or renovate facilities, to 
purchase equipment, hire additional staff, or to comply with other requirements of law 
concerning its planning, financing, or operation. If a health service is offered, the hospital 
shall not discriminate between persons holding a degree of doctor of medicine, doctor of 
osteopathy, or doctor of podiatric medicine who are authorized by law to perform such 
services. 

(3) A hospital may require the coadmittance by a medical doctor or doctor of osteop- 
athy for any patient admitted for surgical treatment by a podiatrist or dentist. The 
responsibility for obtaining such coadmittance shall be that of the podiatrist or dentist 
admitting said patient and not of the hospital. Patients admitted for podiatric or dental care 
shall receive the same basic medical appraisal as patients admitted for other services. Such 
appraisal shall include an admission history and physical examination by a medical doctor, 
doctor of osteopathy, or qualified, hospital-credentialed and -privileged podiatrist, who is 
either on the medical staff or approved by the medical staff of such hospital. The findings 
of such appraisal shall be recorded on the patient's medical record. The admitting podiatrist 
or dentist shall be responsible for that part of the history and examination that is related to 
podiatry or dentistry. The medical doctor or doctor of osteopathy shall be responsible for the 
treatment of any medical problem that may be present on admission or arise during 
hospitalization of such podiatric or dental patient. Such doctor shall evaluate the general 
medical condition of the podiatric or dental patient and determine, after consultation if 
necessary, the overall risk of the pending surgical treatment to the patient's health. 

(4) Within one hundred eighty days after May 25, 1983, the governing body of every 
hospital subject to the provisions of part 3 of this article or established pursuant to section 
32-1-1003, C.R.S., which does not limit staff privileges to employees or contracting 
physicians of such hospital, shall provide in its bylaws reasonable standards and procedures 
to be applied by such hospital and its staff in considering and acting upon applications for 
staff membership or privileges by a person holding a Colorado license to practice as a 
doctor of medicine, doctor of osteopathic medicine, podiatrist, or dentist in conformance 
with the requirements of any national accrediting body to which the hospital subscribes. 
Such standards and procedures shall be available for public inspection and shall be based 
on an applicant's individual training, experience, current competence, professional ethics, 
health status, and the hospital's rules of professional conduct applied equally to all persons 
holding a Colorado license to practice as a doctor of medicine, doctor of osteopathic 
medicine, podiatrist, or dentist. 

(5) Hospital rules and regulations shall be reasonable, necessary, and applied in good 
faith equally and in a nondiscriminatory manner to all staff members, or applicants seeking 
to become staff members, holding a degree of doctor of medicine, doctor of osteopathic 
medicine, doctor of dental science, or doctor of podiatric medicine. 



25-3-103.7 Health Title 25 - page 132 

Source: L. 83: Entire section added, p. 1053, § 1, effective May 25. L. 2007: (3) 

amended, p. 436, § 1, effective August 3. 

25-3-103.7. Employment of physicians - when permissible - conditions - defini- 
tions. (1) For purposes of this section: 

(a) "Community mental health center" means a community mental health center, as 
defined in section 25-1.5-103 (2), that is currently licensed and regulated by the department 
pursuant to the department's authority under section 25-1.5-103 (1) (a). 

(b) "Department" means the department of public health and environment. 

(c) "Federally qualified health center" or "FQHC" shall have the same meaning as set 
forth in section 1861(aa) (4) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa) 
(4). 

(d) "Health care facility" means a hospital, hospice, community mental health center, 
federally qualified health center, school-based health center, rural health clinic, PACE 
organization, or long-term care facility. 

(e) "Hospice" means an entity that administers services to a terminally ill person 
utilizing palliative care or treatment and that is currently licensed and regulated by the 
department pursuant to the department's authority under section 25-1.5-103 (1) (a). 

(f) "Hospital" means a hospital currently licensed or certified by the department 
pursuant to the department's authority under section 25-1.5-103 (1) (a). 

(f.3) "Long-term care facility" means: 

(1) A nursing facihty as defined by section 25.5-4-103, C.R.S., and licensed pursuant to 
section 25-1.5-103; 

(II) An assisted living residence as defined by section 25-27-102 and licensed pursuant 
to section 25-27-103; or 

(III) An independent living facility or a residence for seniors that provides assistance to 
its residents in the performance of their daily living activities. 

(f.5) "PACE organization" means an organization providing a program of all-inclusive 
care for the elderly pursuant to section 25.5-5-412, C.R.S. 

(g) "Physician" means a person duly licensed to practice under article 32, 35, or 36 of 
title 12, C.R.S. 

(h) "Rural health cUnic" shall have the same meaning as set forth in section 1861(aa) 
(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa) (2). 

(i) "School-based health center" shall have the same meaning as set forth in section 
25-20.5-502. 

(2) (a) A health care facility may employ physicians, subject to the limitations set forth 
in subsections (3) to (6) of this section. The employment of physicians at a long-term care 
facility may be direct or through a separate entity authorized to conduct business in this 
state that has common or overlapping ownership as an affiliate or subsidiary of an entity, 
including a foreign entity, that owns, controls, or manages the long-term care facility, 
subject to the limitations set forth in subsections (3) to (6) of this section. 

(b) Nothing in this subsection (2) allows any person who is not licensed pursuant to 
article 36 of title 12, C.R.S., to practice or direct the practice of medicine at a long-term care 
facility. 

(3) Nothing in this section shall be construed to allow any health care facility that 
employs a physician to limit or otherwise exercise control over the physician's independent 
professional judgment concerning the practice of medicine or diagnosis or treatment or to 
require physicians to refer exclusively to the health care facility or to the health care 
facility's employed physicians. Any health care facility that knowingly or recklessly so 
limits or controls a physician in such manner or attempts to do so shall be deemed to have 
violated standards of operation for the particular type of health care facility and may be held 
liable to the patient or the physician, or both, for such violations, including proximately 
caused damages. Nothing in this section shall be construed to affect any health care 
facility's decisions with respect to the availability of services, technology, equipment, 
facilities, or treatment programs, or as requiring any health care facility to make available 
to patients or physicians additional services, technology, equipment, facilities, or treatment 
programs. 



Title 25 - page 133 Hospitals 25-3-103.7 

(4) Nothing in this section shall be construed to allow a health care facility that employs 
a physician to offer the physician any percentage of fees charged to patients by the health 
care facility or other financial incentive to artificially increase services provided to patients. 

(5) The medical staff bylaws or policies or the policies of any health care facility that 
employs physicians shall not discriminate with regard to credentials or staff privileges on 
the basis of whether a physician is an employee of, a physician with staff privileges at, or 
a contracting physician with, the health care facility. Any health care facility that discrimi- 
nates with regard to credentials or staff privileges on the basis of whether a physician is an 
employee of, a physician with staff privileges at, or a contracting physician with, the health 
care facility shall be deemed to have violated standards of operation for the particular type 
of health care facility and may be held liable to the physician for such violations, including 
proximately caused damages. This subsection (5) shall not affect the terms of any contract 
or written employment arrangement that provides that the credentials or staff and clinical 
privileges of any practitioner are incident to or coterminous with the contract or employ- 
ment arrangement or the individual's association with a group holding the contract. 

(6) When applying for initial facility licensure and upon each application for license 
renewal, every health care facility licensed or certified by the department that employs a 
physician shall report to the department the number of physicians on the health care 
facility's medical staff. The report shall separately identify the number of those physicians 
who are employed by the health care facility under separate contract to the health care 
facility and independent of the health care facility. 

(7) The medical staff bylaws or policies or the policies of any health care facility that 
employs physicians shall contain a procedure by which complaints by physicians alleging 
a violation of subsection (3), (4), or (5) of this section may be heard and resolved, which 
procedure shall ensure that the due process rights of the parties are protected. A physician 
who believes he or she has been the subject of a violation of subsection (3), (4), or (5) of 
this section has a right to complain and request review of the matter pursuant to such 
procedure. 

(8) Nothing in this section shall preclude a physician or a patient from seeking other 
remedies available to the physician or to the patient at law or in equity. 

Source: L. 93: Entire section added, p. 721, § 2, effective May 6. L. 94: (l)(a) and (6) 
amended, p. 2751, § 407, effective July 1. L. 95: (l)(a), (3), and (5) amended and (7) and 
(8) added, p. 977, § 2, effective July 1. L. 2003: (l)(a) amended, p. 709, § 38, effective 
July 1. L. 2007: (1) to (7) amended, p. 452, § 1, effective April ILL. 2008: Entire section 
amended, p. 932, § 1, effective August 5. L. 2009: (l)(d) and (6) amended and (l)(f.5) 
added, (HB 09-1004), ch. 26, p. 115, § 1, effective March 19. L. 2011: (l)(d) and (2) 
amended and (l)(f.3) added, (SB 11-084), ch. 112, p. 346, § 2, effective August 10. 
L. 2012: (6) amended, (HB 12-1052), ch. 228, p. 1006, § 4, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(l)(a) and (6), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legisladve 
declaration contained in the 1995 act amending subsections (l)(a), (3), and (5) and adding subsections 
(7) and (8), see section 1 of chapter 201, Session Laws of Colorado 1995. For the legislative 
declaradon in the 2012 act amending subsection (6), see section 1 of chapter 228, Session Laws of 
Colorado 2012. 

ANNOTATION 

Law reviews. For article, "The Physician as liability with respect to negligent or tortious acts 

the Hospital's Employee: SB 95-212", see 24 committed by the physician employee. Estate of 

Colo. Law. 2345 (1995). Harper ex rel. Al-Hamim v. Denver Health & 

No exposure to vicarious liability. Since a Hosp. Auth., 140 P.3d 273 (Colo. App. 2006). 
hospital may employ a physician but cannot Corporate practice of medicine doctrine is 

limit or otherwise exercise control over the phy- statutorily altered, but not abolished, in Col- 

sician's independent professional judgment, this orado. Daly v. Aspen Ctr. for Women's Health, 

section does not expose the hospital to vicarious Inc., 134 P.3d 450 (Colo. App. 2005). 



25-3-104 Health Title 25 - page 134 

25-3-104. Reports. Any person, partnership, association, or corporation maintaining 
any hospital or other facility for the treatment or care of the sick or injured shall make a 
report to the department of public health and environment upon request but not more 
frequently than quarterly. The department of public health and environment shall have 
power to investigate and shall have free access to such facilities consistent with section 
25-1.5-103 (1) (a). 

Source: L. 09: p. 412, § 4. C.L. § 1056. CSA: C. 78, § 136. CRS 53: § 66-4-4. 
C.R.S. 1963: § 66-4-4. L. 71: p. 632, § 4. L. 94: Entire section amended, p. 2752, 
§ 408, effective July 1. L. 95: Entire section amended, p. 1024, § 6, effective July 1. 
L. 2003: Entire section amended, p. 709, § 39, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-3-105. License - fee - rules - penalty. ( 1 ) (a) (I) (A) Subject to the limitations in 
sub- subparagraph (B) of this subparagraph (I), the state board of health shall establish a 
schedule of fees, which must be set at a level sufficient to meet the direct and indirect costs 
of administration and enforcement of this article, as appropriated by the general assembly 
for each fiscal year, less any moneys appropriated for the same fiscal year by the general 
assembly from any other source to meet such costs. The fee schedule must also ensure that 
the reserve balance in the health facilities general licensure cash fund created in section 
25-3-103.1 (1) is consistent with the limits specified in section 24-75-402 (3), C.R.S. , and 
must be modified, as necessary, to comply with said limits. The state board shall establish 
and modify, as necessary, the fee schedule by rules adopted in accordance with article 4 of 
title 24, C.R.S. Except as specified in subparagraph (II) of this paragraph (a), the department 
of public health and environment may assess fees in accordance with the fee schedule 
established by the state board against health facilities licensed by the department. All fees 
collected pursuant to the fee schedule must be deposited in the health facilities general 
licensure cash fund created in section 25-3-103.1 (1) and are subject to appropriation by the 
general assembly in accordance with section 25-3-103.1 (2). 

(B) On or after June 4, 2012, the state board of health may increase the amount of any 
fee on the schedule of fees established pursuant to sub-subparagraph (A) of this subpara- 
graph (I) that is in effect on June 4, 2012, by an amount not to exceed the annual percentage 
change in the United States department of labor, bureau of labor statistics, consumer price 
index for Denver-Boulder-Greeley for all urban consumers, all goods, or its successor 
index. Nothing in this sub-subparagraph (B) limits the ability of the state board of health to 
reduce the amount of any fee on the schedule of fees in effect on such date or to modify fees 
as necessary to comply with section 24-75-402, C.R.S. 

(C) The department of public health and environment shall institute, by rule, a 
performance incentive system for licensed health facilities under which a licensed health 
facility would be eligible for a reduction in its license renewal fee if: The department's 
on-site relicensure inspection demonstrates that the health facility has no significant 
deficiencies that have negatively affected the life, safety, or health of its consumers; the 
licensed health facility has fully and timely cooperated with the department during the 
on-site inspection; the department has found no documented actual or potential harm to 
consumers; and, in the case where any significant deficiencies are found that do not 
negatively affect the life, safety, or health of consumers, the licensed health facility has 
submitted, and the department has accepted, a plan of correction and the health facility has 
corrected the deficient practice, as verified by the department, within the period required by 
the department. 

(II) An acute treatment unit shall be assessed a fee as set forth in paragraph (c) of this 
subsection (1), an assisted living residence shall be assessed a fee as set forth in section 
25-27-107, and a separate fee shall be collected pursuant to section 25-3-704 to meet the 
costs incurred by the department in completing the requirements of part 7 of this article. 

(III) A license issued by the department may be revoked at any time by the state board 
of health for any of the causes set forth in section 25-3-103 or for a licensee's failure to 



Title 25 - page 1 35 Hospitals 25-3- 1 05 

comply with any of the rules of the state board or to make the reports required by section 
25-3-104. Any person, partnership, association, company, or corporation opening, conduct- 
ing, or maintaining any facility for the treatment and care of the sick or injured who does 
not have a provisional or regular license authorizing such person or entity to open, conduct, 
or maintain the facility is guilty of a misdemeanor and, upon conviction thereof, shall be 
punished by a fine of not less than fifty dollars nor more than five hundred dollars. 

(b) (Deleted by amendment, L. 2007, p. 953, § 2, effective May 17, 2007.) 

(c) (I) On and after August 7, 2006, an applicant for licensure for an acute treatment 
unit shall submit to the department nonrefundable fees with an application for licensure as 
follows: 

(A) A fee of one hundred dollars per available bed in addition to a fee of three thousand 
five hundred dollars for a license related to new facility operations; except that a facility that 
converts from a different licensure category to an acute treatment unit shall submit its 
application and initial licensure fee no later than July 1, 2008; 

(B) A fee of twenty dollars per available bed in addition to a fee of one thousand seven 
hundred dollars to issue a new license when there has been a change of ownership of an 
existing licensed acute treatment unit; 

(C) A fee of twenty dollars per available bed in addition to a fee of one thousand five 
hundred dollars when the licensee seeks annual renewal of an existing acute treatment unit 
license. 

(II) A licensee shall submit a fee of one hundred dollars for an acute treatment unit in 
the following circumstances: 

(A) When submitting a name change for approval by the department; or 

(B) When submitting a request to increase the number of licensed beds for approval by 
the department. 

(III) A licensee shall submit a fee of five hundred dollars for an acute treatment unit in 
the following circumstances: 

(A) For remodeling plan review by the department when the licensee undergoes new 
construction or substantial remodeling of an acute treatment unit, as defined by rule of the 
state board of health; or 

(B) For remodeling on-site review by the department when the licensee undergoes new 
construction or substantial remodeling of an acute treatment unit, as defined by rule of the 
state board of health. Fees for remodeling on-site review shall be in addition to the fees 
assessed for remodeling plan review. 

(2) The department of public health and environment shall maintain a full, true, and 
accurate accounting of the costs of providing services under this article, including indirect 
costs, and, at least annually, shall provide a detailed cost accounting report to the health care 
facility stakeholder forum created in section 25-3-113. The department shall regularly 
evaluate and update its cost-accounting methods. 

(3) Repealed. 

(4) On July 1, 2013, any moneys remaining in the health facilities general licensure 
cash fund created in section 25-3-103.1 (1) from fees collected by the department of public 
health and environment for health facility building and structure code plan reviews and 
inspections are transferred to the health facility construction and inspection cash fund 
created in section 24-33.5-1207.8, C.R.S. 

Editor's note: Subsection (4) is effective July 1, 2013, only if the revisor of statutes receives 
notification. (See the editor's note following this section.) 

Source: L. 09: p. 413, § 6. C.L. § 1058. CSA: C. 78, § 138. CRS 53: § 66-4-5. 
L. 54: p. 133, § 1. C.R.S. 1963: § 66-4-5. L. 71: p. 632, § 5. L. 77: Entire section 
amended, p. 1275, § 1, effective July 1. L. 95: Entire section amended, p. 1025, § 7, 
effective July 1. L. 98: (1) amended, p. 1333, § 45, effective June 1. L. 2000: (2) 
amended, p. 461, § 2, effective August 2. L. 2003: (l)(a) amended, p. 1524, § 1, effective 
May 1. L. 2006: (1) amended, p. 1391, § 25, effective August 7. L. 2007: (l)(a) and (l)(b) 
amended, p. 953, § 2, effective May 17. L. 2012: (l)(a)(I) and (2) amended, (HB 
12-1294), ch. 252, p. 1257, § 7, effective June 4; (4) added (HB 12-1268), ch. 234, p. 1026, 
§ 3, effective July 1, 2013. 



25-3-106 Health Title 25 - page 136 

Editor's note: (1) Subsection (3)(b) provided for the repeal of subsection (3), effective July 1, 
1996. (See L. 95, p. 1025.) 

(2) Section 15 of chapter 234, Session Laws of Colorado 2012, provides that subsection (4) is 
effective July 1, 2013, only if the division of fire prevention and control in the department of public 
safety notifies the re visor of statutes in writing, by June 30, 2013, that the secretary of the United 
States department of health and human services has granted a modification to the agreement entered 
into between said secretary and the state of Colorado pursuant to section 1864 of the federal "Social 
Security Act", 42 U.S.C. sec. 1395aa, which modification allows said division to fulfill the duties 
under that law associated with the assessment of compliance with the federal fire safety code 
requirements for health facilities. 

Cross references: For the legislative declaration in the 2012 act amending subsections (l)(a)(I) and 
(2), see section 1 of chapter 252, Session Laws of Colorado 2012. 

25-3-106. Unincorporated associations. An unincorporated association organized and 
existing for the purpose of providing hospital services for its members shall be governed, 
managed, and controlled by a board of trustees selected in accordance with the provisions 
of the state constitution and bylaws of such association. Such board of trustees shall have 
the right to acquire, own, and hold, in the name of such association or in the name of 
persons who hold title in trust for said association, real property devoted to or connected 
with hospital purposes and to operate and manage the same in accordance with the laws of 
this state, and such board of trustees shall have the power and right from time to time to sell, 
convey, lease, or otherwise dispose of such property, including any hospital building of such 
association, whenever acquired, and to direct the sale, conveyance, lease, or other dispo- 
sition of the same by persons who hold the title to such property in trust for said association 
to such purchaser, lessee, or other person or entity for such price and upon such terms and 
conditions as may be determined by resolution of the board of trustees of the association 
adopted by two-thirds vote of the entire board of trustees of such association at any regular 
or special meeting of said board. The sale, conveyance, lease, or other disposition of such 
property may be made in the manner provided in this section to any person, corporation, 
county, municipality, or other entity. 

Source: L. 57: p. 416, § 1. CRS 53: § 66-4-6. C.R.S. 1963: § 66-4-6. 

25-3-107. Disciplinary actions reported to Colorado medical board or podiatry 
board. ( 1 ) Any disciplinary action to suspend, revoke, or otherwise limit the privileges of 
a licensed physician or podiatrist that is taken by the governing board of a hospital required 
to be licensed or certified pursuant to this part 1 or required to obtain a certificate of 
compliance pursuant to section 25-1.5-103 (1) (a) (I) or (1) (a) (II) shall be reported to the 
Colorado medical board or the Colorado podiatry board, whichever board is appropriate, in 
the form prescribed by said board. 

(2) Said hospital shall provide such additional information as is deemed necessary by 
the Colorado medical board or the Colorado podiatry board to conduct a further investi- 
gation and hearing. 

Source: L. 76: Entire section added, p. 421, § 7, effective July 1. L. 79: (1) amended, 
p. 523, § 28, effective July 1. L. 85: Entire section amended, p. 505, § 23, effective July 
1. L. 88: (1) amended, p. 527, § 11, effective July 1. L. 2003: (1) amended, p. 710, § 40, 
effective July 1. L. 2010: Entire section amended, (HB 10-1260), ch. 403, p. 1990, § 86, 
effective July 1. 

25-3-108. Receivership. (1) It is the purpose of this section to establish a receiver- 
ship mechanism that will be available as a remedy for such violations of applicable laws and 
regulations by a licensee of a long-term health care facility that require facility closure by 
the department of public health and environment in order to safeguard against potential 
transfer trauma resulting from relocation of its residents as a result of closure of the facility. 

(2) The department of public health and environment, the licensee or owner of a 
long-term health care facility, or the lessee of such facility with the approval of the owner 



Title 25 - page 137 Hospitals 25-3-108 

may apply to the district court for the appointment of a receiver to operate the long-term 
health care facility when: 

(a) The department of public health and environment has refused to issue a renewal 
license or has revoked the license of such facility and the action of the department is final; 
or 

(b) The department of public health and environment, through the executive director 
thereof, has taken summary action to suspend the license of any such facility in accordance 
with the provisions of section 24-4-104 (4), C.R.S. 

(3) The action of the department of public health and environment with respect to 
nonrenewal or revocation of a license and recommendation for certification for medicaid 
participation shall not be final for the purposes of paragraph (a) of subsection (2) of this 
section until all administrative hearings and judicial appeals sought by a licensee of a 
long-term health care facility have been exhausted or the time permitted for the same has 
expired and until the decisions resulting from any such appeals, if any, sustain the action of 
said department. 

(4) Application for the appointment of a receiver pursuant to this section shall be to the 
district court for the county where the long-term health care facility is located. No hearing 
on such application shall be held sooner than seventy-two hours after the licensee of such 
facility has been served with notice thereof, as provided in the Colorado rules of civil 
procedure; except that when the department exercises its summary powers, an emergency 
receiver may be appointed upon agreement in writing between the department and licensee, 
with the approval of the owner, until a hearing for appointment of a receiver as provided in 
this section. Notice shall also be served upon any owner and any lessee of a long-term 
health care facility and any holder of a security interest of record in said facility. An 
application for appointment of a receiver pursuant to this section shall have precedence and 
priority over any civil or criminal case pending in the district court wherein the application 
is filed. 

(5) For the purposes of this section the action of the department of public health and 
environment exercised pursuant to subsection (2) of this section shall become effective 
upon appointment of the receiver of the court. 

(6) Prior to ordering the appointment of a receiver for the operation of a long-term 
health care facility, the district court must find: 

(a) That grounds for the appointment of a receiver exist as provided in subsection (2) 
of this section; and 

(b) That proper notice as required by subsection (4) of this section has been served; and 

(c) That there is a necessity to continue care on a temporary basis at the facility to avoid 
potential transfer trauma which would serve the best interests of the residents of the facility 
pending arrangements for the lease, sale, or closure of the facility. 

(7) The department of public health and environment shall grant the receiver a license 
pursuant to section 25-3-102 and shall recommend certification for medicaid participation, 
and the department of health care policy and financing shall reimburse the receiver for the 
long-term health care facility's medicaid residents pursuant to section 25.5-6-204, C.R.S. 

(8) The appointment of the receiver shall be in accordance with and governed by the 
provisions of rule 66 of the Colorado rules of civil procedure. The court shall enter an order 
of appointment and fix the fees and expenses of the receiver. The receiver shall be a licensed 
nursing home administrator and shall post a bond with adequate sureties as determined by 
the court, and the receiver may be sued upon the same in the name of the people of the state 
of Colorado at the instance and for the use of any party injured. The receiver shall perform 
duties, assume responsibilities, and preserve the long-term health care facility property in 
accordance with established principles of law for receivers of real property. Such duties and 
responsibilities shall be determined by the court following a hearing, at which time the 
parties may appear and be heard. The court shall specify the duties and responsibilities of 
the receiver in the order of appointment. No security interest in any real or personal property 
comprising said facility or contained within the facility nor any fixture of the facility shall 
be impaired or diminished by the receiver, but the receiver shall comply with the standards 
of the department of public health and environment in providing health care to patients. 



25-3-109 



Health 



Title 25 -page 138 



(9) Nothing in this section shall prevent the court from altering or amending the terms 
and conditions of the receivership or the receiver's responsibilities and duties following a 
hearing, at which time the parties may appear and be heard; and nothing in this section shall 
prohibit the parties from stipulating to the terms and conditions of the receivership and the 
responsibilities and duties of the receiver, including the duration thereof, and such stipu- 
lation shall be submitted to the court for approval. 

(10) A receivership established pursuant to this section may be terminated by the court 
upon application therefor by the licensee of a long-term health care facility, the department 
of public health and environment, or the receiver. The receivership may be terminated upon 
a finding by the court that the receivership is no longer necessary, but in no case shall the 
receivership continue for longer than one hundred eighty days from the date of the initial 
appointment of the receiver unless extended by written agreement of the parties as provided 
in subsection (9) of this section. 

(11) Upon termination of the receivership, the court shall order a final accounting and 
finally fix the fees and expenses of the receiver following a hearing, at which time the 
parties may appear and be heard. 

Source: L. 79: Entire section added, p. 1003, § 1, effective June 7. L. 91: (7) amended, 
p. 1857, § 15, effective April 11. L. 94: (1), (2), (3), (5), (7), (8), and (10) amended, pp. 
2752, 2624, §§ 409, 43, effective July 1. L. 2006: (7) amended, p. 2015, § 89, effective 
July 1. L. 2007: (1) amended, p. 2040, § 64, effective June 1. 

Editor's note: Amendments to subsection (7) by sections 43 and 409 of House Bill 94-1029 were 
harmonized. 

Cross references: For the legislafive declarafion contained in the 1994 act amending subsections 

(1), (2), (3), (5), (7), (8), and (10), see section 1 of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 



Law reviews. For article, "Smith v. 
G'Halloran: Nursing Home Reform in the 
Courts", see 13 Colo. Law. 2248 (1984). 

This section modifies the general rule that a 
receiver stands in the shoes of the entity in 
receivership and may assert no greater rights 
than the entity whose property the receiver was 
appointed to receive. Rather, to implement the 
statutory purpose to avoid "transfer trauma" 
from relocation of patients, the Department of 
Social Services is required to reimburse a re- 
ceiver appointed pursuant to this section for its 



medicaid residents in accordance with § 26-4- 
110 (5). Thus, despite an apparent conflict with 
its regulations, the Department may not with- 
hold the final month's payment claimed by a 
receiver pending completion of audits. Good 
Shepherd v. Dept. of Health, 789 R2d 423 
(Colo. App. 1989). 

Applied in State ex rel. State Dept. of Health 
V. I.D.L, Inc., 642 R2d 14 (Colo. App. 1981); In 
re Estate of Smith v. G'Halloran, 557 F. Supp. 
289 (D. Colo. 1983). 



25-3-109. Quality management functions - confidentiality and immunity. (1) The 

general assembly hereby finds and declares that the implementation of quality management 
functions to evaluate and improve patient and resident care is essential to the operation of 
health care facilities licensed or certified by the department of public health and environ- 
ment pursuant to section 25-1.5-103 (1) (a). For this purpose, it is necessary that the 
collection of information and data by such licensed or certified health care facilities be 
reasonably unfettered so a complete and thorough evaluation and improvement of the 
quality of patient and resident care can be accomplished. To this end, quality management 
information relating to the evaluation or improvement of the quality of health care services 
shall be confidential, subject to the provisions of subsection (4) of this section, and persons 
performing such functions shall be granted qualified immunity. It is the intent of the general 
assembly that nothing in this section revise, amend, or alter article 36 or part 1 of article 
36.5 of title 12, C.R.S. 

(2) For purposes of this section, a "quality management program" means a program 
which includes quality assurance and risk management activities, the peer review of 
licensed health care professionals not otherwise provided for in part 1 of article 36.5 of title 



Title 25 - page 1 39 Hospitals 25-3- 1 09 

12, C.R.S., and other quality management functions which are described by a facility in a 
quality management program approved by the department of public health and environ- 
ment. Nothing in this section shall revise, amend, or alter article 36 or part 1 of article 36.5 
of title 12, C.R.S. 

(3) Except as otherwise provided in this section, any records, reports, or other infor- 
mation of a licensed or certified health care facility that are part of a quality management 
program designed to identify, evaluate, and reduce the risk of patient or resident injury 
associated with care or to improve the quality of patient care shall be confidential 
information; except that such information shall be subject to the provisions of subsection (4) 
of this section. 

(4) The records, reports, and other information described in subsection (3) and sub- 
section (5.5) of this section shall not be subject to subpoena or discoverable or admissible 
as evidence in any civil or administrative proceeding. No person who participates in the 
reporting, collection, evaluation, or use of such quality management information with 
regard to a specific circumstance shall testify thereon in any civil or administrative 
proceeding. However, this subsection (4) shall not apply to: 

(a) Any civil or administrative proceeding, inspection, or investigation as otherwise 
provided by law by the department of public health and environment or other appropriate 
regulatory agency having jurisdiction for disciplinary or licensing sanctions; 

(b) Persons giving testimony concerning facts of which they have personal knowledge 
acquired independently of the quality management information program or function; 

(c) The availability, as provided by law or the rules of civil procedure, of factual 
information relating solely to the individual in interest in a civil suit by such person, next 
friend or legal representative. In no event shall such factual information include opinions or 
evaluations performed as a part of the quality management program. 

(d) Persons giving testimony concerning an act or omission which they have observed 
or in which they participated, notwithstanding any participation by them in the quality 
management program; 

(e) Persons giving testimony concerning facts they have recorded in a medical record 
relating solely to the individual in interest in a civil suit by such person. 

(5) Nothing in this section shall affect the voluntary release of any quality management 
record or information by a health care facility; except that no patient-identifying informa- 
tion shall be released without the patient's consent. 

(5.5) (a) The confidentiality of information provided for in this section shall in no way 
be impaired or otherwise adversely affected solely by reason of the submission of the 
information to a nongovernmental entity to conduct studies that evaluate, develop, and 
analyze information about health care operations, practices, or any other function of health 
care facilities. The records, reports, and other information collected or developed by a 
nongovernmental entity shall remain protected as provided in subsections (3) and (4) of this 
section. In order to adequately protect the confidentiality of such information, no findings, 
conclusions, or recommendations contained in such studies conducted by any such non- 
governmental entity shall be deemed to establish a standard of care for health care facilities. 

(b) For purposes of this subsection (5.5), "health care facility" includes a health carrier 
as defined in section 10-16-102 (8), C.R.S., and a health care practitioner licensed or 
certified pursuant to title 12, C.R.S. 

(6) Any person who in good faith and within the scope of the functions of a quality 
management program participates in the reporting, collection, evaluation, or use of quality 
management information or performs other functions as part of a quality management 
program with regard to a specific circumstance shall be immune from suit in any civil action 
based on such functions brought by a health care provider or person to whom the quality 
information pertains. In no event shall this immunity apply to any negligent or intentional 
act or omission in the provision of care. 

(7) and (8) (Deleted by amendment, L. 97, p. 507, § 2, effective April 24, 1997.) 

(9) Nothing in this section shall be construed to limit any statutory or common law 
privilege, confidentiality, or immunity. 

(10) Nothing in this section shall revise, amend, or alter the requirements of section 
25-3-107. 



25-3-110 



Health 



Title 25 - page 140 



(11) (Deleted by amendment, L. 97, p. 507, § 2, effective April 24, 1997.) 

(12) Nothing in this section shall affect a person's access to his medical record as 
provided in section 25-1-801, nor shall it affect the right of any family member or any other 
person to obtain medical record information upon the consent of the patient or his 
authorized representative. 

Source: L. 88: Entire section added, p. 1006, § 1, effective April 29. L. 89: (1) and (2) 
amended, p. 689, § 5, effective July 1. L. 94: (1), (2), (3), (4)(a), IP(7), and (8) amended, 
p. 2754, § 410, effective July 1. L. 97: (1), (3), (7), (8), and (11) amended, p. 507, § 2, 
effective April 24. L. 2003: IP(4) amended and (5.5) added, p. 942, § 1, effective April 17; 
(1) amended, p. 710, § 41, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(1), (2), (3), and (4)(a), the introductory portion to subsection (7), and subsection (8), see section 1 
of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 



The federal Protection and Advocacy for 
Mentally 111 Individuals Act (PAMII) requires 
disclosure of peer review and quality assur- 
ance records. To the extent Colorado's laws 
conflict with PAMII and the access to peer re- 
view and medical assurance records that PAMII 
provides, they are preempted. Ctr. for Legal 
Advocacy v. Hammons, 323 F.3d 1262 (10th 
Cir. 2003). 

Documents that exist regardless of any 
quality management functions undertaken 
pursuant to a state approved quality manage- 
ment program are discoverable, but only from 
their original source; and conversations between 
or among health care providers about medical 
care before a qualifying quality management 
function is initiated or outside the operation of a 
qualifying quality management function are not 



privileged. Zander v. Craig Hosp., 743 F. Supp. 
2d 1225 (D. Colo. 2010). 

Doctor's investigation, undertaken on his 
own, was outside the scope of hospital's qual- 
ity management program and is not privi- 
leged. Doctor's belief and expectation that hos- 
pital would initiate a quality management 
review does not alter the independent nature of 
doctor's investigation or make it privileged. 
Zander v. Craig Hosp., 743 F Supp. 2d 1225 (D. 
Colo. 2010). 

A wrongful discharge claim could not be 
predicated on this section where, with regard 
to the employee's conduct at issue, this section 
neither established a public duty nor created an 
important job-related right or privilege. Jaynes 
v. Centura Health Corp., 148 P3d 241 (Colo. 
App. 2006). 



25-3-110. Emergency contraception - definitions. (1) For purposes of this section, 
unless the context otherwise requires: 

(a) "Emergency contraception" means a drug approved by the federal food and drug 
administration that prevents pregnancy after sexual intercourse, including but not limited to 
oral contraceptive pills; except that "emergency contraception" shall not include RU-486, 
mifepristone, or any other drug or device that induces a medical abortion. Nothing in 
section 2-4-401 (1.5), C.R.S., shall be construed to amend or alter the definition of 
"emergency contraception". 

(b) "Sexual assault survivor" shall have the same meaning as "victim" as defined in 
section 18-3-401 (7), C.R.S. 

(2) Notwithstanding any other provision of law to the contrary, all health care facilities 
that are licensed pursuant to this part 1 and provide emergency care to sexual assault 
survivors shall amend their evidence-collection protocols for the treatment of sexual assault 
survivors to include informing the survivor in a timely manner of the availability of 
emergency contraception as a means of pregnancy prophylaxis and educating the survivor 
on the proper use of emergency contraception and the appropriate follow-up care. 

(3) Nothing in this section shall be interpreted to require: 

(a) A health care professional who is employed by a health care facility that provides 
emergency care to a sexual assault survivor to inform the survivor of the availability of 
emergency contraception if the professional refuses to provide the information on the basis 
of religious or moral beliefs; or 



Title 25 - page 141 Hospitals 25-3-112 

(b) A health care facility to provide emergency contraception to a sexual assault 
survivor who is not at risk of becoming pregnant as a result of the sexual assault or who was 
already pregnant at the time of the assault. 

(4) If any licensed pharmacy does not have nonprescription emergency contraception in 
stock, the pharmacy shall place a conspicuous notice in the area where customers obtain 
prescription drugs that states "Plan B Emergency Contraception Not Available". 

(5) The general assembly encourages health care facilities to provide training to 
emergency room staff concerning the efficacy of emergency contraception and the time- 
sensitive nature of the drug. 

(6) Because emergency contraception is time-sensitive and a sexual assault survivor 
may seek information on or direct access to emergency contraception to prevent an 
unintended pregnancy resulting from the assault instead of or prior to seeking hospital 
treatment, it is critical that sexual assault survivors have accurate information about the 
availability and use of emergency contraception. Therefore, the general assembly encour- 
ages: 

(a) Entities offering victim assistance or counseling and rape crisis hotlines to include 
information concerning the availability and use of emergency contraception; and 

(b) Licensed or registered pharmacies in the state of Colorado to distribute information 
concerning the availability and use of emergency contraception. 

Source: L. 2007: Entire section added, p. 63, § 2, effective March 15. L. 2009: (l)(a) 
amended, (SB 09-225), ch. 126, p. 546, § 2, effective August 5. 

Cross references: For the legislative declaration contained in the 2007 act enacting this section, see 
section 1 of chapter 24, Session Laws of Colorado 2007. 

25-3-111. Authentication of verbal orders - hospital policies or bylaws. (1) A 

hospital licensed pursuant to part 3 of this article shall require that all verbal orders be 
authenticated by a physician or responsible individual who has the authority to issue verbal 
orders in accordance with hospital and medical staff policies or bylaws. The policies or 
bylaws shall require that: 

(a) Authentication of a verbal order occurs within forty-eight hours after the time the 
order is made unless a read-back and verify process pursuant to paragraph (b) of this 
subsection (1) is used. The individual receiving a verbal order shall record in writing the 
date and time of the verbal order, and sign the verbal order in accordance with hospital 
policies or medical staff bylaws. 

(b) A hospital policy may provide for a read-back and verify process for verbal orders. 
A read-back and verify process shall require that the individual receiving the order 
immediately read back the order to the physician or responsible individual, who shall 
immediately verify that the read-back order is correct. The individual receiving the verbal 
order shall record in writing that the order was read back and verified. If the read-back and 
verify process is followed, the verbal order shall be authenticated within thirty days after the 
date of the patient's discharge. 

(2) Verbal orders shall be used infrequently. Nothing in this section shall be interpreted 
to encourage the more frequent use of verbal orders by the medical staff at a hospital. 

Source: L. 2010: Entire section added, (HB 10-1229), ch. 199, p. 869, § 1, effective 
May 5. 

25-3-112. Hospitals - charges for the uninsured - collections protection - charity 
care information. (1) Each hospital shall make information available to each patient 
about the hospital's financial assistance, charity care, and payment plan policies. Each 
hospital shall communicate this information in a clear and understandable manner and in 
languages appropriate to the communities and patients the hospital serves. The hospital 
shall: 

(a) Post the information conspicuously on its web site; 



25-3-1 13 Health Title 25 - page 142 

(b) Make the information available in patient waiting areas; 

(c) Make the information available to each patient, when possible, before the patient's 
discharge from the hospital; and 

(d) Include the information in each patient's billing statement. 

(2) (a) When possible, each hospital shall offer to screen each uninsured patient for 
eligibility for financial assistance as described by this subsection (2). Each hospital shall 
offer financial assistance for qualified patients on a community-specific basis. In determin- 
ing eligibility for financial assistance, each hospital shall, at a minimum, take into 
consideration federal, state, and local government requirements. 

(b) For purposes of this section, a qualified patient is an individual: 

(1) Who is uninsured; 

(II) Whose annual family income is not more than two hundred fifty percent of the 
federal poverty guidelines; and 

(III) Who received a service at a hospital for which the "Colorado Indigent Care 
Program" established in part 1 of article 3 of title 25.5, C.R.S., was not available. 

(3) A hospital shall limit the amounts charged for emergency or other medically 
necessary care provided to individuals eligible for assistance under the financial assistance 
policy described in subsection (2) of this section to not more than the lowest negotiated rate 
from a private health plan. 

(4) Before initiating collection proceedings, a hospital shall: 

(a) Offer a qualified patient a reasonable payment plan; and 

(b) Allow for at least thirty days past the due date of any scheduled payment that is not 
paid in full. A hospital must allow the thirty-day period only for the first late payment. 

(5) Nothing in this section limits or affects a hospital's right to pursue the collection of 
personal injury, bodily injury, liability, uninsured, underinsured, medical payment rehabil- 
itation, disability, homeowner's, business owner's, workers' compensation, or fault-based 
insurance. 

(6) For the purposes of this section, "hospital" means a hospital licensed pursuant to 
part 1 of article 3 of this title or certified pursuant to section 25-1.5-103 (1) (a) (II). 

Source: L. 2012: Entire section added, (SB 12-134), ch. 162, p. 569, § 1, effective 
August 8. 

25-3-113. Health care facility stakeholder forum - creation - membership - duties. 

(1) There is hereby created in the department of public health and environment the health 
care facility stakeholder forum, referred to in this section as the "stakeholder forum". The 
stakeholder forum must consist of representatives from various types of provider facilities 
licensed by the department, consumers, consumer advocates, ombudsmen, and other 
interested parties. The department shall meet at least four times each year with the 
stakeholder forum to discuss and take into consideration the concerns and issues of interest 
to the forum members and other attendees regarding the development and implementation 
of rules and other matters that affect all health care facilities licensed by the department. 

(2) The members of the stakeholder forum serve on a voluntary basis without com- 
pensation and are responsible for noticing, staffing, recording, and reporting the notes from 
the stakeholder forum meetings. The department shall consider the attendance of its 
representatives at meetings with the stakeholder forum to be within the normal course of 
business, with no additional appropriation to or resources from the department required. 

(3) The stakeholder forum and the department shall work to coordinate with, and shall 
not duplicate the work being done by, estabUshed or statutorily authorized advisory 
committees or working groups on issues related to the development and implementation of 
rules. 

(4) For purposes of section 24-4-103 (2), C.R.S., as amended by House Bill 12-1008, 
enacted in 2012, the department may use the stakeholder forum described in this section, 
when appropriate, to serve as the representative group for the department of public health 
and environment. 



Title 25 - page 143 Hospitals 25-3-302 

Source: L. 2012: Entire section added, (HB 12-1294), ch. 252, p. 1258, § 8, effective 
June 4. 

Editor's note: Subsection (4) is effective June 4, 2012, only if House Bill 12-1008 is enacted and 
becomes law. Said bill was signed by the governor on May 17, 2012. 

Cross references: For the legislative declaration in the 2012 act adding this section, see section 1 
of chapter 252, Session Laws of Colorado 2012. 

PART 2 
MATERNITY HOSPITALS 

25-3-201 to 25-3-207. (Repealed) 

Source: L. 96: Entire part repealed, p. 561, § 23, effective April 24. 

Editor's note: This part 2 was numbered as article 5 of chapter 66, C.R.S. 1963. For amendments 
to this part 2 prior to its repeal in 1996, consult the Colorado statutory research explanatory note and 
the table itemizing the replacement volumes and supplements to the original volume of C.R.S. 1973 
beginning on page vii in the front of this volume. 

PART 3 

COUNTY HOSPITALS - ESTABLISHMENT 

25-3-301. Establishment of public hospital. (1) Whenever the board of county 
commissioners of any county which has a population of at least three thousand is presented 
with a petition signed by five hundred resident registered qualified electors, or by fifty 
percent of the resident registered qualified electors of such county, at least two hundred fifty 
of whom are residents of other than the county seat or town where it is proposed to locate 
such public hospital, asking that a public hospital board be appointed and that an annual tax 
be levied for the establishment and maintenance of a public hospital at a place in the county 
named therein, and which petition shall specify the maximum amount of money proposed 
to be expended in purchasing or building said hospital, such board of county commissioners 
shall have the power to create, by resolution, such public hospital board, to levy such tax, 
and to appropriate to such public hospital board the funds for purchasing or building such 
hospital and for maintaining the hospital, as well as the power to turn to the control and 
maintenance of such public hospital board any public or other hospital then being conducted 
by the board of county commissioners. Said tax shall not exceed three mills on the dollar 
for each year. 

(2) If it is proposed in such petition, or in a petition later filed with like number of 
resident registered qualified elector signers, to create an indebtedness of the county for 
purchasing, erecting, or enlarging of buildings or equipment for such public hospital, then 
the board of county commissioners shall submit such question in the manner provided by 
law for creating debt for erecting public buildings and, if the vote authorizes it, shall issue 
such bonds, so authorized, as the public hospital board requests. In those counties having 
a population of less than three thousand, a public hospital board may be created by the 
petition of not less than fifty-one percent of the resident registered qualified electors or two 
hundred such resident registered qualified electors, regardless of where they live in the 
county. In such counties, an annual levy of not to exceed five mills on the dollar shall be 
assessed to purchase, build, and maintain such a county hospital. 

Source: L. 43: p. 275, § 1. CSA: C. 78, § 151(1). L. 53: p. 342, § 1. CRS 53: 
§ 66-7-1. C.R.S. 1963: § 66-7-1. L. 70: p. 140, § 9. L. 71: p. 634, § 1. 

25-3-302. Board of trustees. (1) If the board of county commissioners decides to 
create such public hospital board, levy such annual tax, and appropriate funds to purchase. 



25-3-303 Health Title 25 - page 144 

erect, and maintain or turn over to it control of such county hospital, the board of county 
commissioners shall proceed at once to appoint, for designated terms, a board of seven 
public hospital trustees chosen from the citizens at large with reference to their fitness for 
such office, all of whom shall be residents of the county and none of whom shall be an 
elective or appointive state, county, or city official. Not more than four of said hospital 
trustees shall be residents of the city or town in which said hospital is to be located. Nothing 
in this article shall require that a licensed physician be appointed to the board of hospital 
trustees; however, should a licensed physician be appointed to the board, membership on 
that board shall be limited to one licensed physician at any given time. The seven appointees 
shall constitute the board of hospital trustees for said public hospital. Such board shall be 

a body corporate under the name "Board of Trustees for Hospital", the name of 

the hospital being inserted in the blank. 

(2) One of the trustees, so designated in such original appointment, shall hold office 
until the second Tuesday of January following his appointment, one until the second 
Tuesday of the second January following his appointment, two until the second Tuesday of 
the third January following their appointment, one until the second Tuesday of the fourth 
January following his appointment, and two until the second Tuesday of the fifth January 
from their appointment. Thereafter, the term of office of each appointee shall be five years 
from the end of the preceding term. At the expiration of the term of each of said trustees, 
the office shall be filled by appointment of the board of county commissioners. 

(3) In those counties having a population of less than three thousand, the board of 
public hospital trustees shall consist of five citizens at large having the same requirements 
with reference to their fitness for such office as all other counties. One of said trustees, so 
designated in such original appointment, shall hold office until the second Tuesday of 
January following his appointment, one until the second Tuesday of the second January 
following his appointment, one until the second Tuesday of the third January following his 
appointment, one until the second Tuesday of the fourth January following his appointment, 
and one until the second Tuesday of the fifth January following his appointment. The term 
of office and the method of filling vacancies shall be the same as for all other counties. 

Source: L. 43: p. 276, § 2. L. 47: p. 503, § 1. CSA: C. 78, § 151(2). L. 53: p. 343, 
§ 2. CRS 53: § 66-7-2. C.R.S. 1963: § 66-7-2. L. 84: (1) amended, p. 752, § 1, 
effective March 5. 

25-3-303. Organization of trustees. ( 1 ) The members of the board of public hospital 
trustees within ten days after their appointment shall qualify by taking the oath of office. On 
the second Tuesday of each January, they shall organize and operate as follows: 

(a) Unless otherwise authorized under the provisions of paragraph (b) of this subsection 
(1), they shall elect one of their number as president, one as vice-president, and one as 
secretary. No bond shall be required of them. The county treasurer of the county shall be 
treasurer of the board of trustees and shall receive and pay out all moneys under the control 
of said board as ordered by it but shall receive no compensation from such board. No trustee 
shall receive any compensation for services performed but may receive reimbursement for 
any cash expenditures actually made for personal expenses incurred as such trustee. An 
itemized statement of all such expenses and money paid out shall be made under oath by 
such trustee and filed with the secretary and allowed only by the affirmative vote of all the 
trustees present at a meeting of the board. 

(b) If approved by resolution of the board of county commissioners, the board may 
organize and operate by electing one of their number as president, one as vice-president, and 
one as secretary-treasurer. The trustees may appoint an assistant secretary-treasurer from 
outside the membership of the board of trustees. No bond shall be required of the trustees, 
except of the secretary-treasurer and assistant secretary-treasurer who shall each file with 
the board of trustees, at the expense of the hospital, a corporate fidelity bond in an amount 
not less than ten thousand dollars, conditioned on the faithful performance of the duties of 
his office. The secretary-treasurer shall receive and pay out all the moneys under the control 
of the board of trustees as ordered by it. No trustee shall receive any compensation for 
services performed, but may receive reimbursement for any cash expenditures actually 



Title 25 - page 145 Hospitals 25-3-304 

made for personal expenses incurred as such trustee. An itemized statement of all such 
expenses and money paid out shall be made under oath by such trustee and filed with the 
secretary-treasurer and allowed only by the affirmative vote of all the trustees present at a 
meeting of the board. 

(2) For purposes of part 4 of article 6 of title 24, C.R.S., any board of public hospital 
trustees created pursuant to section 25-3-302 shall continue to be a local public body, as 
defined in section 24-6-402 (1) (a), C.R.S., regardless of whether the hospital governed by 
such board of trustees is designated an enterprise pursuant to section 25-3-304 (3). 

Source: L. 43: p. 276, § 3. CSA: C. 78, § 151(3). CRS 53: § 66-7-3. C.R.S. 1963: 

§ 66-7-3. L. 73: p. 690, § 1. L. 93: (2) added, p. 1819, § 2, effective June 6. 

25-3-304. Trustees - powers and duties. (1) The board of public hospital trustees 
shall make and adopt such bylaws, rules, and regulations for its own guidance and for the 
government of the hospital as it deems expedient for the economic and equitable conduct 
thereof, not inconsistent with state law or the ordinances of the city or town wherein such 
public hospital is located. The public hospital board shall have the exclusive control of the 
use and expenditure of all moneys collected to the credit of the hospital, including the right 
to invest or have invested hospital moneys and funds held by the hospital or in the office 
of the county treasurer and to receive the interest and income therefrom, and of the purchase 
of sites, the purchase, construction, or enlargement of any hospital building, and the 
supervision, care, and custody of the grounds, rooms, or buildings purchased, constructed, 
leased, or set apart for that purpose. The hospital board may acquire by lease real and 
personal property subject to the approval of the board of county commissioners. All tax 
moneys received for hospital purposes shall be paid out of the county treasury only upon 
warrants drawn by the county commissioners upon sworn vouchers approved by the 
hospital board. All other moneys received for such hospital shall be deposited in the treasury 
of the hospital and paid out only upon order of said hospital board. Hospital property and 
facilities, including real and personal property, may be acquired and held by lease or 
conveyance on transfer of title, but if by conveyance title to all lands shall be in the name 
of the county. County hospitals situated in home rule counties shall have the additional 
borrowing authority as granted by section 30-35-201 (23) (b), C.R.S. 

(2) The board of public hospital trustees shall have power to hire, retain, and remove 
agents and employees, including administrative, nursing, and professional personnel, 
engineers, architects, and attorneys, and to fix their compensation; shall have the power to 
borrow money and incur indebtedness, and to issue bonds and other evidence of such 
indebtedness; except that no indebtedness shall be created, except as otherwise provided by 
statute, in excess of the revenue which may reasonably be expected to be available to the 
hospital for repayment thereof in the fiscal year in which such indebtedness is to be created, 
and except that no such indebtedness shall be incurred without the approval of the board of 
county commissioners; and shall in general carry out the spirit and intent of this part 3 in 
establishing and maintaining a county public hospital. Such board of public hospital trustees 
shall hold meetings at least once each month and shall keep a complete record of all its 
proceedings. Four members of the board shall constitute a quorum for the transaction of 
business. One of the trustees shall visit and examine said hospital at least twice each month, 
and the public hospital board, during the first week in each January and July, shall file with 
the board of county commissioners a report of their proceedings with reference to such 
hospital and a statement of all receipts and expenditures during the half year. On or before 
each October first, the board shall certify to the board of county commissioners the amount 
necessary to maintain and improve said hospital for the ensuing year. No trustee shall have 
a personal pecuniary interest, either directly or indirectly, in the purchase of any supplies for 
said hospital, unless the same are purchased by competitive bidding. 

(3) (a) The board of public hospital trustees may, in accordance with the provisions of 
paragraph (b) of this subsection (3), designate the hospital as an enterprise for purposes of 
section 20 of article X of the state constitution so long as said board of trustees retains 
authority to issue revenue bonds and the hospital receives less than ten percent of its total 
annual revenues in grants. So long as the hospital is designated as an enterprise pursuant to 



25-3-304 Health Title 25 - page 146 

the provisions of this subsection (3), the hospital shall not be subject to any of the provisions 
of section 20 of article X of the state constitution. 

(b) (I) The board of public hospital trustees may, by resolution, designate the hospital 
as an enterprise as long as the hospital meets the requirements for an enterprise as stated in 
paragraph (a) of this subsection (3). Such designation shall be effective beginning with the 
budget year immediately following the budget year in which such resolution is adopted. 
Such resolution shall be adopted no sooner than ninety days and no later than thirty days 
prior to the commencement of the budget year in which such designation becomes effective. 

(II) The board of public hospital trustees may, by resolution, revoke the designation of 
the hospital as an enterprise. Such revocation shall be effective beginning with the budget 
year immediately following the budget year in which such resolution is adopted. Such 
resolution shall be adopted no sooner than ninety days and no later than thirty days prior to 
the commencement of the budget year in which such revocation becomes effective. 

(III) Upon adoption of any resolution pursuant to the provisions of subparagraph (I) or 
(II) of this paragraph (b), the board of public hospital trustees shall transmit a copy of the 
resolution to the division of local government in the department of local affairs and the 
appropriate board or boards of county commissioners. 

(IV) The termination or revocation of the designation of the hospital as an enterprise 
shall not affect in any manner the validity of any revenue bonds issued by the board of 
pubHc hospital trustees of such hospital pursuant to subsection (4) of this section. 

(c) (I) For purposes of this subsection (3), "grant" means any direct cash subsidy or 
other direct contribution of money from the state or any local government in Colorado 
which is not required to be repaid. 

(II) "Grant" does not include: 

(A) Any indirect benefit conferred upon a hospital from the state or any local govern- 
ment in Colorado; 

(B) Any revenues resulting from rates, fees, assessments, or other charges imposed by 
a hospital for the provision of goods or services by such hospital; 

(C) Any federal funds, regardless of whether such federal funds pass through the state 
or any local government in Colorado prior to receipt by a hospital. 

(4) (a) Subject to the limitations set forth in paragraph (b) of this subsection (4), the 
board of public hospital trustees shall have the power to issue revenue bonds, secured by 
any revenues of the hospital other than property tax revenues. Notwithstanding subsection 
(2) of this section to the contrary, such revenue bonds may provide for their repayment over 
a term greater than one fiscal year. The board shall authorize the issuance of revenue bonds 
by resolution, duly approved by no less than two-thirds of the entire membership of the 
board. All bonds shall be signed by the president of the board of trustees, countersigned by 
the secretary of the board of trustees, and shall be numbered and registered in a book kept 
by the secretary or the secretary-treasurer, as applicable. Each bond shall state upon its face 
the amount for which such bond is issued, to whom such bond is issued, and the date of its 
issuance. 

(b) Except as otherwise provided in this paragraph (b), the issuance of any revenue 
bonds pursuant to the provisions of this subsection (4) shall not become effective for a 
period of thirty days following the adoption of any resolution authorizing such issuance for 
the purpose of allowing the board of county commissioners to review such pending bond 
issue. Such review period shall commence upon the date of receipt by the board of county 
commissioners of written notice from the board of public hospital trustees of such pending 
revenue bond issue. During said thirty days, the board of county commissioners may file a 
written notice with the board of trustees stating that the board of county commissioners has 
no objection to such pending bond issue. Upon receipt of such notice of no objection, the 
issuance of such revenue bonds shall become effective. If, within said thirty days, the board 
of county commissioners does not file with the board of trustees either a written notice of 
no objection or a written objection, the issuance of such revenue bonds shall become 
effective. If the board of county commissioners files a written objection, the issuance of 
such revenue bonds shall be prohibited until such time as the board of county commis- 
sioners gives written notice to the board of trustees of withdrawal of the board's objection. 



Title 25 - page 147 Hospitals 25-3-310 

Source: L. 43: p. 277, § 4. CSA: C. 78, § 151(4). CRS 53: § 66-7-4. C.R.S. 1963: 

§ 66-7-4. L. 73: p. 691, § 2. L. 81: (1) amended, p. 1486, § 2, effective June 8. L. 93: 
(3) and (4) added, p. 1817, § 1, effective June 6. L. 94: (3)(c)(II)(B) amended, p. 1640, 
§ 59, effective May 31. 

25-3-305. Vacancies - removal for cause. Vacancies in the board of trustees occa- 
sioned by removals, resignations, or otherwise shall be reported to the board of county 
commissioners and be filled in like manner as original appointments. Any trustee may be 
removed for cause by the board of county commissioners. 

Source: L. 43: p. 278, § 5. CSA: C. 78, § 151(5). CRS 53: § 66-7-5. C.R.S. 1963: 

§ 66-7-5. 

25-3-306. Right of eminent domain. If the board of public hospital trustees and the 
owners of any property desired by it for hospital purposes cannot agree as to the price to 
be paid therefor, said board shall report the facts to the board of county commissioners, and 
condemnation proceedings shall be instituted by the board of county commissioners and 
prosecuted in the name of the county wherein such public hospital is to be located. 

Source: L. 43: p. 278, § 6. CSA: C. 78, § 151(6). CRS 53: § 66-7-6. C.R.S. 1963: 

§ 66-7-6. 

25-3-307. Building requirements. No hospital buildings shall be erected or con- 
structed until the plans and specifications have been made therefor and adopted by the board 
of public hospital trustees and bids advertised for according to law as for other county 
public buildings. Such hospital may be in more than one unit or set of buildings within the 
same town or city, or in separate towns or cities, or within adjacent counties, and, if in 
adjacent counties, upon approval of the respective boards of county commissioners. 

Source: L. 43: p. 278, § 7. CSA: C. 78, § 151(7). L. 51: p. 442, § 1. CRS 53: 
§ 66-7-7. C.R.S. 1963: § 66-7-7. L. 73: p. 692, § 3. 

25-3-308. Improvements or enlargements. In counties exercising the rights conferred 
by this part 3, the board of county commissioners may appropriate each year, in addition to 
the tax for hospital fund provided for in section 25-3-301, not more than five percent of its 
general fund for the improvement or enlargement of any public hospital so established. 

Source: L. 43: p. 278, § 8. CSA: C. 78, § 151(8). CRS 53: § 66-7-8. C.R.S. 1963: 

§ 66-7-8. 

25-3-309. Hospital fees. Every hospital established under this part 3 shall be for the 
benefit of the inhabitants of such county and of any person falling sick or being injured or 
maimed within its limits. Every inhabitant or person who is not a pauper shall pay to the 
board of public hospital trustees or such officer as it shall designate for such county public 
hospital a reasonable compensation for occupancy, nursing, laboratories, care, medicine, or 
attendants according to the rules and regulations prescribed by said board in order to render 
the use of said hospital of the greatest benefit to the greatest number. 

Source: L. 43: p. 278, § 9. CSA: C. 78, § 151(9). CRS 53: § 66-7-9. C.R.S. 1963: 

§ 66-7-9. 

25-3-310. Rules and regulations. (1) When such hospital is established, the physi- 
cians, nurses, attendants, persons sick therein, and persons approaching or coming within 
the limits of same and all buildings and grounds of such hospital and all furniture and other 



25-3-3 1 1 Health Title 25 - page 148 

articles used or brought there shall be subject to such rules and regulations as said public 
hospital board may prescribe. 

(2) Said public hospital board may exclude from the use of such hospital any inhab- 
itants and persons who willfully violate such rules and regulations. The board may extend 
the privileges and use of such hospital to persons residing outside of such county upon such 
terms and conditions as said board may from time to time by its rules and regulations 
prescribe. 

Source: L. 43: p. 279, § 10. CSA: C. 78, § 151(10). CRS 53: § 66-7-10. 
C.R.S. 1963: § 66-7-10. 

25-3-311. Donations permitted. Any person, firm, organization, corporation, or soci- 
ety desiring to make donations of money, personal property, or real estate for the benefit of 
such public hospital shall have the right to vest title of the money, personal property, or real 
estate so donated in said county, to be controlled, when accepted, by the board of public 
hospital trustees according to the terms of the deed, gift, devise, or bequest of such property. 

Source: L. 43: p. 279, § 11. CSA: C. 78, § 151(11). CRS 53: § 66-7-11. 
C.R.S. 1963: § 66-7-11. L. 83: Entire section amended, p. 2050, § 16, effective October 
14. 

25-3-312. Training school for nurses. The board of trustees of such county public 
hospital may establish and maintain, in connection therewith and as a part of said public 
hospital, a training school for nurses. 

Source: L. 43: p. 279, § 12. CSA: C. 78, § 151(12). CRS 53: § 66-7-12. 
C.R.S. 1963: § 66-7-12. 

25-3-313. Lease of hospital. The public hospital board having control of such hospital 
after its establishment and turning over to its management may in its discretion rent or lease 
the said hospital, for such rental and for such term as it deems reasonable and proper, to any 
corporation not for pecuniary profit duly organized under the laws of the state of Colorado 
for the purpose of conducting a hospital. 

Source: L. 43: p. 279, § 13. CSA: C. 78, § 151(13). CRS 53: § 66-7-13. 
C.R.S. 1963: § 66-7-13. 

25-3-314. Charge for professional services. Any hospital which is owned by a county, 
or by a city and county, having a population in excess of two hundred fifty thousand persons 
and which is a teaching hospital duly accredited as such by the joint commission on 
accreditation of hospitals and by the council on medical education of the American medical 
association may employ physicians and surgeons licensed to practice medicine in the state 
of Colorado for the performance of professional services in such hospital or in any related 
outpatient facility which is owned by such county or city and county. Charges for the 
services so rendered by any such physician or surgeon, excluding professional trainees, may 
be collected through the medium of such hospital in the name of the physician or surgeon 
and, upon collection, may be placed in a medical practice fund to be established, main- 
tained, and used by such hospital solely for the purpose of payment of compensation to the 
physicians and surgeons so employed and for the payment of consultation fees to other 
physicians and surgeons not so employed, or directly to physicians and surgeons who are 
directly engaged in medical research or medical education. 

Source: L. 67: p. 306, § 1. C.R.S. 1963: § 66-7-14. L. 94: Entire section amended, p. 
671, § 4, effective April 19. 



Title 25 - page 149 Hospitals 25-3-403 

25-3-315. Records of hospital. For purposes of part 2 of article 72 of title 24, C.R.S., 
the records of any hospital established pursuant to this part 3 shall continue to be public 
records, as defined in section 24-72-202 (6), C.R.S., regardless of whether such hospital is 
designated as an enterprise pursuant to section 25-3-304 (3). 

Source: L. 93: Entire section added, p. 1819, § 3, effective June 6, 

PART 4 

STATE PLAN FOR IMPLEMENTATION OF FEDERAL ACT FOR THE 
CONSTRUCTION OF HEALTH FACILITIES 

25-3-401. Department to administer plan. (1) The department of public health and 
environment is designated as the sole agency for carrying out the purposes of the federal 
"Hospital Survey and Construction Act", Public Law 79-725 of the 79th Congress of the 
United States, approved August 13, 1946, or any amendments thereto, and the successor 
provisions thereof of Public Law 93-641, and is authorized to formulate, submit, and 
administer a state plan for carrying out the provisions thereof and to accept on behalf of the 
state any funds allotted to the state under the provision of the said federal acts, or any 
amendments thereto. In carrying out the purposes of this section, the department of public 
health and environment is authorized to make such reports as may be required by the said 
federal acts, or any amendments thereto, and to do all things that may be required as a 
condition precedent to the proper application for the receipt of federal grants under the said 
federal acts, and any amendments thereto and regulations thereof, and to administer and 
supervise the expenditure of such grants for the purposes of this section. 

(2) The state plan established under subsection (1) of this section shall provide for 
adequate hospital facilities for the people residing in the state, without discrimination on 
account of race, creed, or color, and shall provide for adequate hospital facilities for persons 
unable to pay therefor. The department of public health and environment shall provide 
minimum standards for the maintenance and operation of hospitals which receive federal 
aid under this part 4, and compliance with such standards shall be required in the case of 
hospitals which have received federal aid under the provisions of said federal acts, or any 
amendments thereto. 

Source: L. 47: p. 500, § l.CSA:C. 78, § 151(14). CRS 53: § 66-18-1. C.R.S. 1963: 
§ 66-18-1. L. 78: Entire section amended, p. 425, § 3, effective July 1. L. 94: Entire 
section amended, p. 2756, § 415, effective July 1. L. 96: (2) amended, p. 1471, § 18, 
effective June 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-3-402. State advisory hospital and mental retardation facilities and community 
mental health centers council. (Repealed) 

Source: L. 47: p. 501, § 2. CSA: C. 78, § 151(15). CRS 53: § 66-18-2. C.R.S. 1963: 
§ 66-18-2. L. 64: p. 481, § 2. L. 65: p. 706, § 1. L. 78: Entire section repealed, p. 425, 
§ 4, effective July 1 . 

25-3-403. Department to administer federal mental retardation and mental health 
construction funds. The department of public health and environment is designated as the 
sole agency for carrying out the purposes of Part C of Title I and Title II of the federal 
"Mental Retardation Facilities and Community Mental Health Centers Construction Act of 
1963", Public Law 88-164 of the 88th congress of the United States, approved October 31, 
1963, or any amendments thereto, and is authorized to administer a state plan for carrying 
out the provisions thereof and to accept, on behalf of the state, all funds allotted to the state 



25-3-501 Health Title 25 - page 150 

under the provisions of said federal act, or any amendments thereto. Such state plan shall 
be formulated by the state mental health and mental retardation authority. In carrying out 
the purposes hereof, the department of public health and environment is authorized to make 
such reports as may be required by said federal act, or any amendments thereto, and to do 
all things that may be required as a condition precedent to the proper application for the 
receipt of federal grants under said federal act, and any amendments thereto and regulations 
thereof, and to administer and supervise the expenditure of such grants for the purposes 
hereof in consultation with the mental health and mental retardation authority of the state 
of Colorado. 

Source: L. 64: p. 480, § l.C.R.S. 1963: § 66-18-3. L. 94: Entire section amended, p. 
2756, § 416, effective July 1. 

Cross references: (1) For the "Mental Retardation Facilities and Community Mental Health 
Centers Construction Act of 1963", see 42 U.S.C. sec. 6000 et seq.; for designation of the department 
of human services as the official mental health and mental retardation authority, see § 27-66-106. 

(2) For the legislative declaration contained in the 1994 act amending this section, see section 1 
of chapter 345, Session Laws of Colorado 1994. 

PART 5 

CERTIFICATE OF PUBLIC NECESSITY 

25-3-501 to 25-3-521. (Repealed) 

Editor's note: (1) This part 5 was numbered as article 41 of chapter 66, C.R.S. 1963. For 
amendments to this part 5 prior to its repeal in 1987, consult the Colorado statutory research 
explanatory note and the table itemizing the replacement volumes and supplements to the original 
volume of C.R.S. 1973 beginning on page vii in the front of this volume. 

(2) Pursuant to § 25-3-521, as enacted by section 1 of chapter 107, Session Laws of Colorado 
1982, this part 5 was to be repealed effective July 1 after the date congress repealed state requirements 
for certificates of public necessity as provided in Pub.L. 93-641. Such requirements were repealed by 
Pub.L. 99-660, effective January 1, 1987. This part 5 was therefore repealed effective July 1, 1987. 

PART 6 

HOSPITAL- ACQUIRED INFECTIONS DISCLOSURE 

25-3-601. Definitions. As used in this part 6, unless the context otherwise requires: 

(1) "Advisory committee" means the advisory committee created pursuant to section 
25-3-602 (4). 

(2) "Department" means the department of public health and environment. 

(3) "Health facihty" means a hospital, a hospital unit, an ambulatory surgical center, or 
a dialysis treatment clinic cuiTently licensed or certified by the department pursuant to the 
department's authority under section 25-1.5-103 (1) (a). 

(4) "Hospital-acquired infection" means a localized or systemic condition that results 
from an adverse reaction to the presence of an infectious agent or its toxins that was not 
present or incubating at the time of admission to the health facility. 

(5) "Infection" means the invasion of the body by pathogenic microorganisms that 
reproduce and multiply, causing disease by local cellular injury, secretion of a toxin, or 
antigen-antibody reaction in the host. 

Source: L. 2006: Entire part added, p. 1569, § 1, effective June 2. L. 2007: IP added, 
p. 2041, § 65, effective June 1. 

25-3-602. Health facility reports - repeal. (1) (a) A health facility shall collect data 
on hospital-acquired infection rates for specific clinical procedures, including the following 
categories: 



Title 25 - page 151 Hospitals 25-3-602 

(1) Cardiac surgical site infections; 

(II) Orthopedic surgical site infections; and 

(III) Central line-related bloodstream infections. 

(b) The advisory committee may define criteria to determine when data on a procedure 
Usted in paragraph (a) of this subsection (1) shall be collected. 

(c) An individual who collects data on hospital-acquired infection rates shall take the 
test for the appropriate national certification for infection control and become certified 
within six months after the individual becomes eligible to take the certification test. 
Mandatory national certification requirements shall not apply to individuals collecting data 
on hospital-acquired infections in hospitals licensed for fifty beds or less, licensed ambu- 
latory surgical centers, and certified dialysis treatment centers. Qualifications for these 
individuals may be met through ongoing education, training, experience, or certification, as 
defined by the department. 

(2) Each physician who performs a clinical procedure listed in subsection ( 1 ) of this 
section shall report to the health facility at which the clinical procedure was performed a 
hospital-acquired infection that the physician diagnoses at a follow-up appointment with the 
patient using standardized criteria and methods consistent with guidelines determined by 
the advisory committee. The reports made to the health facility under this subsection (2) 
shall be included in the reporting the health facility makes under subsection (3) of this 
section. 

(3) (a) A health facility shall routinely submit its hospital-acquired infection data to the 
national healthcare safety network in accordance with national healthcare safety network 
requirements and procedures. The data submissions shall begin on or before July 31, 2007, 
and continue thereafter. 

(b) If a health facility is a division or subsidiary of another entity that owns or operates 
other health facilities or related organizations, the data submissions required under this part 
6 shall be for the specific division or subsidiary and not for the other entity. 

(c) Health facilities shall authorize the department to have access to health-facility- 
specific data contained in the national healthcare safety network database consistent with 
the requirements of this part 6. 

(4) (a) The executive director of the department shall appoint an advisory committee. 
The advisory committee shall consist of: 

(I) One representative from a public hospital; 

(II) One representative from a private hospital; 

(III) One board-certified or board-eligible physician licensed in the state of Colorado, 
who is affiliated with a Colorado hospital or medical school, who is an active member of 
a national organization specializing in health care epidemiology or infection control, and 
who has demonstrated an interest and expertise in health facility infection control; 

(IV) Four infection control practitioners as follows: 

(A) One from a stand-alone ambulatory surgical center; and 

(B) Three health care professionals certified by the certification board of infection 
control and epidemiology, inc., or its successor; 

(V) Either one medical statistician with an advanced degree in such specialty or one 
clinical microbiologist with an advanced degree in such specialty; 

(VI) One representative from a health consumer organization; 

(VII) One representative from a health insurer; and 

(VIII) One representative from a purchaser of health insurance. 

(b) The advisory committee shall assist the department in development of the depart- 
ment's oversight of this article and the department's methodology for disclosing the 
information collected under this part 6, including the methods and means for release and 
dissemination. 

(c) The department and the advisory committee shall evaluate on a regular basis the 
quality and accuracy of health-facility information reported under this part 6 and the data 
collection, analysis, and dissemination methodologies. 

(d) The advisory committee shall elect a chair of the advisory committee annually. The 
advisory committee shall meet no less than four times per year in its first year of existence 



25-3-603 Health Title 25 - page 152 

and no less than two times in each subsequent year. The chair shall set the meeting dates 
and times. The members of the advisory committee shall serve without compensation. 

(5) (a) The advisory committee shall recommend additional clinical procedures based 
upon the criteria set forth in paragraph (c) of this subsection (5) that must be reported 
pursuant to subsection ( 1 ) of this section in the manner specified in paragraph (b) of this 
subsection (5). The recommendations of the advisory committee shall be consistent with 
information that may be collected by the national healthcare safety network. 

(b) (I) On or before November 1, 2008, the advisory committee shall either recom- 
mend to the department the addition of abdominal surgical site infections and at least one 
other clinical procedure to the data collected on hospital-acquired infection rates as required 
in this section or comply with the provisions of paragraph (d) of this subsection (5) and shall 
recommend to the department whether to include long-term acute care centers as health 
facilities that are subject to the reporting requirements of this part 6. 

(II) In addition to the requirements of subparagraph (I) of this paragraph (b), on or 
before November 1, 2010, the advisory committee shall either recommend to the depart- 
ment the addition of at least two clinical procedures to the data collected on hospital- 
acquired infection rates as required in this section or comply with the provisions of 
paragraph (d) of this subsection (5). 

(c) In making its recommendations under paragraph (a) or (b) of this subsection (5), the 
advisory committee shall recommend clinical procedures using the following consider- 
ations: 

(1) Whether the procedure contains a high risk for infection contraction; 

(II) Whether the type or types of infection present a serious risk to the patient's health 
or life; and 

(III) Any other factors determined by the advisory committee. 

(d) If the advisory committee determines that it is unable to identify at least two clinical 
procedures for addition to the data collected by the deadline, the committee shall report to 
the department its reasons for not identifying at least two new clinical procedures. 

(6) The advisory committee may recommend that health facilities report process 
measures to the advisory committee, in addition to those listed in subsections (1) and (5) of 
this section, to accommodate best practices for effective prevention of infection. 

(7) (a) Subsections (4), (5), and (6) of this section and this subsection (7) are repealed, 
effective July 1, 2016. 

(b) Prior to such repeal, the advisory committee and its functions shall be reviewed as 
provided for in section 2-3-1203, C.R.S. 

Source: L. 2006: Entire part added, p. 1570, § 1, effective June 2. L. 2009: (l)(c) 
amended, (HB 09-1025), ch. 34, p. 143, § 1, effective August 5. L. 2012: (4)(a)(IV) 
amended, (HB 12-1294), ch. 252, p. 1259, § 9, effective June 4. 

Cross references: For the legislative declaration in the 2012 act amending subsection (4)(a)(IV), 
see section 1 of chapter 252, Session Laws of Colorado 2012. 

25-3-603. Department reports. (1) On or before January 15, 2008, and each January 
15 thereafter, the department shall submit to the health and human services committees of 
the house of representatives and of the senate a report summarizing the risk-adjusted 
health-facility data. The department shall post the report on its web site. 

(2) The department shall issue semi-annual informational bulletins summarizing all or 
part of the information submitted in the health-facility reports. 

(3) (a) All data in reports issued by the department shall be risk-adjusted consistent 
with the standards of the national healthcare safety network. 

(b) The annual report shall compare the risk-adjusted, hospital-acquired infection rates, 
collected under section 25-3-602, for each individual health facility in the state. The 
department, in consultation with the advisory committee, shall make this comparison as 
easy to comprehend as possible. The report shall include an executive summary, written in 
plain language, that includes, but is not limited to, a discussion of findings, conclusions, and 
trends concerning the overall state of hospital-acquired infections in the state, including a 



Title 25 - page 153 Hospitals 25-3-606 

comparison to prior years when available. The report may include policy recommendations 
as appropriate. 

(c) The department shall publicize the report and its availability as widely as practical 
to interested parties, including but not limited to health facilities, providers, media orga- 
nizations, health insurers, health maintenance organizations, purchasers of health insurance, 
organized labor, consumer or patient advocacy groups, and individual consumers. The 
annual report shall be made available to any person upon request. 

(d) A health-facility report or department disclosure may not contain information 
identifying a patient, employee, or licensed health care professional in connection with a 
specific infection incident. 

Source: L. 2006: Entire part added, p. 1572, § 1, effective June 2. 

25-3-604. Privacy. Compliance with this part 6 shall not violate a patient's right to 
confidentiality. A patient's social security number and any other information that could be 
used to identify a patient shall not be released, notwithstanding any other provision of law. 

Source: L. 2006: Entire part added, p. 1573, § 1, effective June 2. 

25-3-605. Confidentiality. (1) Except as provided by subsection (5) of this section, 
all information and materials obtained and compiled by the department under this part 6 or 
compiled by a health facility under this part 6, including all related information and 
materials, are confidential; are not subject to disclosure, discovery, subpoena, or other 
means of legal compulsion for release to any person, subject to subsection (2) of this 
section; and may not be admitted as evidence or otherwise disclosed in a civil, criminal, or 
administrative proceeding. 

(2) The confidential protections under subsection ( 1 ) of this section shall apply without 
regard to whether the information or materials are obtained from or compiled by a health 
facility or an entity that has ownership or management interests in a health facility. 

(3) The transfer of information or materials under this part 6 is not a waiver of a 
privilege or protection granted under law. 

(4) Information reported by a health facility under this part 6 and analyses, plans, 
records, and reports obtained, prepared, or compiled by a health facility under this part 6 
and all related information and materials are subject to an absolute privilege and shall not 
be used in any form against the health facility, its agents, employees, partners, assignees, or 
independent contractors in any civil, criminal, or administrative proceeding, regardless of 
the means by which a person came into possession of the information, analysis, plan, 
record, report, or related information or materials. 

(5) The provisions of this section regarding the confidentiality of information or 
materials compiled or reported by a health facility in compliance with or as authorized 
under this part 6 shall not restrict access, to the extent authorized by law, by the patient or 
the patients' legally authorized representative to records of the patient's medical diagnosis 
or treatment or to other primary health records. 

Source: L. 2006: Entire part added, p. 1573, § 1, effective June 2. 

25-3-606. Penalties. (1) A determination that a health facility has violated the 
provisions of this part 6 may result in the following: 

(a) Termination of licensure or other sanctions related to licensure under part 1 of this 
article; or 

(b) A civil penalty of up to one thousand dollars per violation for each day the health 
facility is in violation of this part 6. 

Source: L. 2006: Entire part added, p. 1574, § 1, effective June 2. 



25-3-607 Health Title 25 - page 154 

25-3-607. Regulatory oversight. The department shall be responsible for ensuring 
compliance with this part 6 as a condition of licensure under part 1 of this article and shall 
enforce compliance according to the provisions in part 1 of this article. 

Source: L. 2006: Entire part added, p. 1574, § 1, effective June 2. 

PART 7 
COLORADO HOSPITAL REPORT CARD ACT 

Editor's note: This part 7 was originally numbered as part 6 in House Bill 06-1278 but has been 
renumbered on revision for ease of location. 

25-3-701. Short title. This part 7 shall be known and may be cited as the "Colorado 
Hospital Report Card Act". 

Source: L. 2006: Entire part added, p. 1576, § 1, effective August 7. 

25-3-702. Comprehensive hospital information system - executive director - duties 
- definitions. (1) (a) The executive director shall approve a comprehensive hospital 
information system to provide for the collection, compilation, coordination, analysis, 
indexing, and utilization of both purposefully collected and extant hospital-related data and 
statistics to produce and report comparable and uniform health information and statistics 
that shall be utilized in the development and production of the report card described in 
section 25-3-703. The executive director shall designate or contract with any individual or 
entity he or she deems appropriate to carry out the purposes of this part 7. 

(b) (I) The association selected pursuant to subsection (3) of this section shall review 
and prepare the nursing-sensitive quality measures set forth in this paragraph (b) for 
inclusion in the hospital information system and hospital report card developed pursuant to 
this part 7. In reviewing and preparing to implement the nursing-sensitive quality measures, 
the association shall determine whether the measures should be reported for the hospital as 
a whole or by unit level of a hospital. In making its determinations pursuant to this 
paragraph (b), the association shall involve and seek input from no more than seven 
direct-care nurses who have been recommended by the governor. 

(II) The association shall collect, review, and implement the following nursing-sensi- 
tive quality measures as soon as practicable: 

(A) Practice environment scale or PES, as defined by the national quality forum, which 
is the nursing work index that measures the composite score and individual scores for the 
following subscales: Nurse participation in hospital affairs; nursing foundations for quality 
of care; nurse manager ability, leadership, and support of nurses; staffmg and resource 
adequacy; and collegiality of nurse-physician relations; and 

(B) Registered nurse education and certification. 

(III) The association shall collect, review, and implement the following nursing- 
sensitive quaUty measures, as defined by the national quality forum, no later than November 
30, 2010: 

(A) Skill mix; 

(B) The nursing hours per patient day; 

(C) Voluntary turnover; 

(D) Patient falls prevalence rate; and 

(E) Patient falls with injury. 

(IV) The association shall identify a process or mechanism to allow access to or use of 
the data collected pursuant to this paragraph (b), as appropriate, for research purposes. 

(V) The association may exempt from the requirements of this paragraph (b) a licensed 
or certified hospital that has not more than one hundred licensed beds. 

(VI) As used in this paragraph (b): 



Title 25 - page 1 55 Hospitals 25-3-702 

(A) "Direct-care nurse" means a registered nurse who is engaged in direct patient care 
responsibilities in an inpatient hospital unit setting for more than fifty percent of his or her 
working hours. 

(B) (Deleted by amendment, L. 2010, (SB 10-217), ch. 315, p. 1474, § 1, effective 
May 27, 2010.) 

(C) "National quality forum" means the private, not-for-profit membership organiza- 
tion created to develop and implement a national strategy for healthcare quality measure- 
ment and reporting, or its successor organization. 

(2) In order to implement this section the executive director or his or her designee shall: 

(a) Develop and implement a long-range plan for making available clinical outcomes 
and data that will allow consumers to compare health care services; 

(b) On or before May 15, 2007, submit an initial plan and an annual update to the plan 
and a report on the status of implementation to the governor, the president of the senate, and 
the speaker of the house of representatives with copies to all members of the general 
assembly and available to the public on an internet web site. The plan shall identify the 
process and time frames for implementation, barriers to implementation, and recommen- 
dations of changes in the law that may be enacted by the general assembly to eliminate the 
barriers. 

(c) Make available clinical outcomes measures from general hospitals licensed pursu- 
ant to this article and public hospitals certified pursuant to section 25-1.5-103 (1) (a). When 
determining which data to report, the executive director or designee shall consider: 

(I) Inclusion of data on all patients regardless of the payer source for Colorado hospitals 
and other information that may be required for either individual or group purchasers to 
assess the value of the product; 

(II) Use of standardized clinical outcomes measures recognized by national organiza- 
tions that establish standards to measure the performance of health care providers; 

(III) Data that is severity and acuity adjusted using statistical methods that show 
variation in reported outcomes, where applicable, and data that has passed standard edits; 

(IV) Reporting the results with separate documents containing the technical specifica- 
tion and measures; 

(V) Standardization in reporting; and 

(VI) Disclosure of the methodology of reporting. 

(3) (a) The executive director shall select a duly constituted association of hospitals for 
assistance in carrying out the purposes of this part 7 and shall rely upon the advice and 
assistance of the selected association. The association shall provide the executive director 
with a copy of the association's organizational documents and any rules or regulations 
governing the association's activities and a list of the association's members. The associ- 
ation shall provide to the executive director a plan outlining the association's inclusion and 
consideration of the interests of health care consumers, including health plans and employ- 
ers, in the process of carrying out the purposes of this part 7. The name and address of a 
representative of the organization, who is a resident of this state, upon whom notices or 
orders of the executive director may be served shall be provided to the executive director. 
The executive director shall have the authority to examine the collection, analysis, and 
validity of the data used as a basis for the reporting required in this part 7. 

(b) The executive director may refuse to accept, or may suspend or revoke the 
acceptance of, an association for any of the following reasons: 

(I) It reasonably appears that the association will not be able to carry out the purpose 
of this part 7. 

(II) The association does not provide to the executive director a plan outlining the 
association's inclusion and consideration of the interests of health care consumers, includ- 
ing health plans and employers, in the process of carrying out the purposes of this part 7. 

(III) On or before April 15, 2007, the association does not submit a plan to the 
executive director and report on the status of its implementation satisfactory to the 
executive director. 

(IV) The association fails to meet other applicable requirements prescribed in this part 
7. 



25-3-703 Health Title 25 - page 156 

(c) There shall not be liability on the part of, nor shall a cause of action of any nature 
arise against, the association or its agents, employees, directors, or authorized designees of 
the executive director for actions taken or omitted in the performance of their powers and 
duties under this section. 

(4) (a) In the event the executive director refuses to accept, or suspends or revokes the 
acceptance of, an association previously accepted for assistance in carrying out the purposes 
of this part 7 for any of the reasons set forth in this part 7, there shall be created in the state 
department the Colorado commission for hospital statistics, referred to in this subsection (4) 
as the "commission", to carry out the purposes of this part 7. 

(b) The commission shall consist of nine members, who shall be appointed by the 
governor with the consent of the senate, as follows: 

(1) Three members representing hospitals licensed under this article; 

(II) Two members representing Ucensed health care providers; and 

(III) Four members representing consumers or businesses without any direct interest in 
hospitals licensed under this article. 

(c) At no time shall the commission have more than five members of any one political 
party. Members of the commission shall be compensated for actual and necessary expenses 
incurred in the conduct of official business. 

(d) The commission shall annually elect the chairman of the commission from its 
members. A majority of the commission shall constitute a quorum. 

(e) The commission shall meet at least once during each calendar quarter. Meeting 
dates shall be set upon written request by three or more members of the commission or by 
a call of the chairman upon five days' notice to the members. 

(f) Action of the commission shall not be taken except upon the affirmative vote of a 
majority of a quorum of the commission. 

(g) All meetings of the commission shall be open to the public pursuant to section 
24-6-402, C.R.S. 

Source: L. 2006: Entire part added, p. 1576, § 1, effective August 7. L. 2008: (1) 

amended, p. 709, § 1, effective August 5. L. 2010: (l)(b)(II)(B) and (l)(b)(VI)(B) 
amended, (SB 10-217), ch. 315, p. 1474, § 1, effective May 27. 

Editor's note: This section was originally numbered as § 25-3-602 in House Bill 06-1278 but has 
been renumbered on revision for ease of location. 

25-3-703. Hospital report card. (1) The executive director shall approve a Colorado 
hospital report card consisting of public disclosure of data assembled pursuant to this part 
7. At a minimum, the data shall be made available on an internet web site in a manner that 
allows consumers to conduct an interactive search that allows them to view and compare the 
information for specific hospitals. The web site shall include such additional information as 
is determined necessary to ensure that the web site enhances informed decision making 
among consumers and health care purchasers, which shall include, at a minimum, appro- 
priate guidance on how to use the data and an explanation of why the data may vary from 
hospital to hospital. The data specified in this subsection (1) shall be released on or before 
November 30, 2007. 

(2) Prior to the completion of the Colorado hospital report card, the executive director 
shall ensure that every hospital is allowed thirty days within which to examine the data and 
submit comments for consideration and inclusion in the final Colorado hospital report card. 

Source: L. 2006: Entire part added, p. 1579, § 1, effective August 7. 

25-3-704. Fees. ( 1 ) The executive director shall annually determine the costs incurred 
by the department and the Colorado commission for hospital statistics in completing the 
requirements of this part 7. 

(2) The executive director shall apportion, according to net patient service revenues, the 
costs annually among the hospitals who pay the annual registration fee required by this 



Title 25 - page 157 Hospitals 25-3-705 

section and report the same to the state board of health. The state board of health by rule 
or as otherwise provided by law may increase the amount of the annual fee imposed by this 
section. At no time shall the fee be higher than what is necessary to implement the report 
required pursuant to this part 7. 

(3) All fees collected pursuant to this part 7 shall be transmitted to the state treasurer, 
who shall credit the same to the health facilities general licensure cash fund created in 
section 25-3-103.1. 

(4) Notwithstanding the amount specified for the fee in this section, the state board of 
health by rule or as otherwise provided by law may reduce the amount of the fee if 
necessary pursuant to section 24-75-402 (3), C.R.S., to reduce the uncommitted reserves of 
the fund to which all or any portion of the fee is credited. After the uncommitted reserves 
of the fund are sufficiently reduced, the state board of health by rule or as otherwise 
provided by law may increase the amount of the fee as provided in section 24-75-402 (4), 
C.R.S. 

Source: L. 2006: Entire part added, p. 1579, § 1, effective August 7. 

25-3-705. Health care charge transparency - hospital charge report. (1) The 

commissioner of insurance shall work with the duly constituted association of hospitals 
selected by the executive director pursuant to section 25-3-702 for assistance in carrying out 
the purposes of this section. 

(2) (a) On or before August 1, 2009, and on or before each August 1 thereafter, each 
hospital licensed pursuant to part 1 of this article shall report annually to the association of 
hospitals the information necessary to allow the association to determine the charges for the 
twenty-five most common inpatient diagnostic-related groups for which there are at least 
ten cases rendered by the hospital during the calendar year immediately preceding the 
release of the hospital charge report. If a hospital does not have twenty-five of the most 
common diagnostic-related groups with at least ten or more cases rendered, the hospital 
shall report only on those most common diagnostic-related groups that have at least ten 
cases rendered. 

(b) A hospital that does not use diagnostic-related groups is exempt from paragraph (a) 
of this subsection (2). 

(3) (a) The commissioner of insurance shall work with the association of hospitals to 
incorporate the information reported pursuant to this section on the web site. 

(b) The commissioner of insurance shall require the association of hospitals to submit 
a plan to the commissioner on or before November 30, 2008, that states the implementation 
status of a plan to make the hospital charges reported pursuant to this section available to 
the public on the web site. The plan shall identify the process and time periods for 
implementation, any barriers to implementation, and recommendations of changes in the 
law that may be enacted by the general assembly to eliminate the barriers. 

(c) When developing the required plan, the association of hospitals shall consider: 

(I) The method for hospitals to report charges to the association; 

(II) Standards that provide for the validity and comparability of hospital charges; and 

(III) The format for making hospital charges available to the public. 

(4) (a) The association of hospitals shall make the information reported by the hospi- 
tals pursuant to this section available on the web site on or before August 1 , 2009, and on 
or before August 1 of each year thereafter. The information reported by the hospitals shall 
include disclaimers regarding factors including case severity ratings and individual patient 
variations that may affect actual charges to a patient for services provided. 

(b) The information reported by the hospitals that is published in accordance with this 
section shall include: 

(I) Volume of cases by diagnostic-related group required to be reported by the hospital; 

(II) Rank by volume of the top twenty-five diagnostic-related groups required to be 
reported by the hospital; 

(III) Mean charge for each of the top twenty-five diagnostic-related groups with more 
than ten occurrences by hospital; 



25-3-705 Health Title 25 - page 158 

(IV) Case severity rating by hospital by diagnostic-related group; and 

(V) A general disclaimer statement regarding the hospital variations and patient varia- 
tions that affect the actual charges to patients. 

(c) Before publication of the information published pursuant to this section on the web 
site, the commissioner shall ensure that every hospital is allowed thirty days within which 
to examine the data and submit comments for consideration and inclusion in the final 
hospital charge report. 

(5) (a) The commissioner of insurance shall approve the publication of information on 
the web site consisting of public disclosure of charge data assembled pursuant to this 
section. At a minimum, the information shall be made available on the web site in a manner 
that allows consumers to conduct an interactive search to view and compare the information 
for specific hospitals. The web site shall include any additional information necessary to 
ensure that the web site information is available to consumers and health care purchasers. 
The information shall include, at a minimum, appropriate guidance on how to use the data 
and an explanation of why the data may vary from hospital to hospital. The report specified 
in this subsection (5) shall be released on the web site on or before August 1, 2009, and on 
or before each August 1 thereafter. 

(b) The commissioner of insurance shall make the web site available by hyperiink on 
the division of insurance web site. 

(c) The division of insurance shall review the information posted on the web site to 
ensure that the web site and information provided by the association is easy to navigate, 
contains consumer-friendly language, and fulfills the intent of this section. The division 
shall also ensure that the hyperlink from the division's web site to the web site is easily 
accessible. 

(6) There shall be no liability on the association of hospitals or a cause of action against 
the association or its agents, employees, or directors or authorized designees of the 
commissioner for actions taken or omitted in the performance of duties pursuant to this 
section. 

(7) Repealed. 

(8) For purposes of this section: 

(a) "Charge" means the amount that a hospital expects to charge for an inpatient 
diagnostic-related group. A charge that is required to be reported to the public shall be the 
mean charge for all cases of the diagnostic-related group occurring in the calendar year prior 
to the release of the hospital charge report. 

(b) "Diagnostic-related group" means the classification assigned to an inpatient hos- 
pital service claim based on the patient's age and sex, the principal and secondary 
diagnoses, the procedures performed, and the discharge status. 

(c) "Web site" means a web site established by the association of hospitals that links 
to the web site created pursuant to section 25-3-703. 

Source: L. 2008: Entire section added, p. 1262, § 3, effective May 27. L. 2011: (7) 
repealed, (HB 11-1303), ch. 264, p. 1165, § 60, effective August 10. 

Cross references: In 2008, this secdon was added by the "Health Care Transparency Act". For the 
short title and legislative declaration, see sections 1 and 2 of chapter 294, Session Laws of Colorado 
2008. 

ARTICLE 3.5 

Emergency Medical and Trauma Services 

Cross references: For exemption from civil liability of persons acdng as volunteer members of 
rescue units, see § 13-21-108. 



Title 25 - page 159 Emergency Medical and Trauma Services 



PART 1 

GENERAL AND ADMINISTRATIVE 

25-3.5-101. Short title. 

25-3.5-102. Legislative declaration. 

25-3.5-103. Definitions. 

25-3.5-104. Emergency medical and trauma 

services advisory council - 

creation - duties. 
25-3.5-104.3. State trauma advisory council - 

duties. (Repealed) 
25-3.5-104.5. Joint advisory council - duties. 

(Repealed) 
25-3.5-105. Rules and regulations. 
25-3.5-106. Local standards - uninterrupted 

service. 
25-3.5-107. Religious exception. 

PART 2 

TREATMENT SUBSYSTEM 

25-3.5-201. Training programs. 

25-3.5-202. Personnel - basic requirements. 

25-3.5-203. Emergency medical service 
providers - certification - re- 
newal of certificate - duties 
of department - rules - crim- 
inal history record checks. 

25-3.5-204. Emergency medical services 
for children. 

25-3.5-205. Emergency medical service 
providers - investigations - 
discipline. 

25-3.5-206. Emergency medical practice 
advisory council - creation - 
powers and duties - emer- 
gency medical service pro- 
vider scope of practice rules. 

PART 3 

TRANSPORTATION SUBSYSTEM 

25-3.5-301. License required - exceptions. 

25-3.5-302. Issuance of licenses and per- 
mits - term - requirements. 

25-3.5-303. Vehicular liability insurance re- 
quired. 

25-3.5-304. Suspension - revocation - hear- 
ings. 

25-3.5-305. Alleged negligence. 

25-3.5-306. Violation - penalty. 

25-3.5-307. Licensure of fixed-wing and ro- 
tor-wing air ambulances - 
cash fund created - rules. 

25-3.5-308. Rules. 

PART 4 

TELECOMMUNICATIONS SUBSYSTEM 

25-3.5-401. Responsibility for coordina- 
tion. 



25-3.5-402. 
25-3.5-403. 



Local government participa- 
tion. 

Poison information center - 
state funding. (Repealed) 

PART 5 



DOCUMENTATION SUBSYSTEM 



25-3.5-501. 
25-3.5-502. 



Records. 

Forms and reports. 

PART 6 



LOCAL EMERGENCY MEDICAL 
SERVICES 



25-3.5-601. 
25-3.5-602. 
25-3.5-603. 



25-3.5-604. 
25-3.5-605. 



25-3.5-606. 
25-3.5-607. 



Legislative declaration. 

Definitions. 

Emergency medical services 
account - creation - alloca- 
tion of funds. 

EMTS grant program - EMS 
account - role of council and 
department - rules - awards. 

Improvement of county emer- 
gency medical and trauma 
services - eligibility for 
county funding - manner of 
distributing funds. 

Annual report. 

Repeal of part. (Repealed) 

PART 7 



STATEWIDE TRAUMA SYSTEM 

25-3.5-701. Short title. 

25-3.5-702. Legislative declaration. 

25-3.5-703. Definitions. 

25-3.5-704. Statewide emergency medical 
and trauma care system - de- 
velopment and implementa- 
tion - duties of department - 
rules adopted by board. 

25-3.5-705. Creation of fee - creation of 
trauma system cash fund. 

25-3.5-706. Immunity from liability. 

25-3.5-707. False representation as trauma 
facility - penalty. 

25-3.5-708. Financing for statewide trauma 
system. 

25-3.5-709. Annual report. 

PART 8 

TOBACCO EDUCATION, PREVENTION, 
AND CESSATION PROGRAMS 

25-3.5-801. Short title. 

25-3.5-802. Legislative declaration. 

25-3.5-803. Definitions. 

25-3.5-804. Tobacco education, prevention, 



25-3.5-101 



Health 



Title 25 - page 160 



and cessation programs - re- 25-3.5-807. 
view committee - grants. 

25-3.5-805. Tobacco education, prevention, 25-3.5-807.5. 
and cessation programs - re- 
quirements. 25-3.5-808. 

25-3.5-806. Tobacco education, prevention, 25-3.5-809. 
and cessation programs - re- 
porting requirements. 



Tobacco program fund - cre- 
ated. (Repealed) 

Transfer of balance of tobacco 
program fund - repeal. 

Administration - limitation. 

Tobacco education, prevention, 
and cessation programs - 
funding. 



PART 1 
GENERAL AND ADMINISTRATIVE 

25-3.5-101. Short title. This article shall be known and may be cited as the "Colorado 
Emergency Medical and Trauma Services Act". 

Source: L. 77: Entire article added, p. 1278, § 2, effective January 1, 1978. L. 2000: 
Entire section amended, p. 525, § 1, effective July 1. 

25-3.5-102. Legislative declaration. ( 1 ) The general assembly hereby declares that it 
is in the public interest to provide available, coordinated, and quality emergency medical 
and trauma services to the people of this state. It is the intent of the general assembly in 
enacting this article to establish an emergency medical and trauma services system, 
consisting of at least treatment, transportation, communication, and documentation subsys- 
tems, designed to prevent premature mortality and to reduce the morbidity that arises from 
critical injuries, exposure to poisonous substances, and illnesses. 

(2) To effect this end, the general assembly finds it necessary that the department of 
public health and environment assist, when requested by local government entities, in 
planning and implementing any one of such subsystems so that it meets local and regional 
needs and requirements and that the department coordinate local systems so that they 
interface with an overall state system providing maximally effective emergency medical 
and trauma systems. 

(3) The general assembly further finds that the provision of adequate emergency 
medical and trauma services on highways in all areas of the state is a matter of statewide 
concern and requires state financial assistance and support. 

Source: L. 77: Entire article added, p. 1278, § 2, effective January 1, 1978. L. 83: (1) 
amended, p. 1055, § 2, effective July 1. L. 89: (3) added, p. 1148, § 1, effective July 1. 
L. 94: (2) amended, p. 2757, § 417, effective July 1. L. 2000: Entire section amended, p. 

525, § 2, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 



Limitation on entities eligible to license 
ambulances. Since the general assembly has 
indicated a coordinated system of emergency 
medical care to be of statewide concern and has 
provided a comprehensive statutory scheme to 
regulate the field, governmental entities other 
than those provided in § 25-3.5-301 may not 
license ambulances. DuHamel v. People ex rel. 
City of Arvada, 42 Colo. App. 491, 601 P.2d 639 
(1979). 



To subject ambulance companies to au- 
thority of two jurisdictions is contrary to 
purpose of section because it fragments the 
coordinated system and could reduce the avail- 
ability of service. DuHamel v. People ex rel. 
City of Arvada, 42 Colo. App. 491, 601 P.2d 639 
(1979). 



Title 25 - page 161 Emergency Medical and Trauma Services 25-3.5-103 

25-3.5-103. Definitions. As used in this article, unless the context otherwise requires: 

(1) "Air ambulance" means a fixed-wing or rotor-wing aircraft that is equipped to 
provide air transportation and is specifically designed to accommodate the medical needs of 
individuals who are ill, injured, or otherwise mentally or physically incapacitated and who 
require in-flight medical supervision. 

(1.5) "Ambulance" means any privately or pubhcly owned ground vehicle: 

(a) Especially constructed or modified and equipped, intended to be used, and main- 
tained or operated by an ambulance service for the transportation, upon the streets and 
highways in this state, of individuals who are sick, injured, or otherwise incapacitated or 
helpless; and 

(b) That is required to be licensed pursuant to part 3 of this article. 

(2) (Deleted by amendment, L. 2005, p. 1330, § 1, effective July 1, 2005.) 

(3) "Ambulance service" means the furnishing, operating, conducting, maintaining, 
advertising, or otherwise engaging in or professing to be engaged in the transportation of 
patients by ambulance. Taken in context, it also means the person so engaged or professing 
to be so engaged. The person so engaged and the vehicles used for the emergency 
transportation of persons injured at a mine are excluded from this definition when the 
personnel utilized in the operation of said vehicles are subject to the mandatory safety 
standards of the federal mine safety and health administration, or its successor agency. 

(3.5) "Board" means the state board of health created pursuant to section 25-1-103. 

(4) "Board of county commissioners" includes the governing body of any city and 
county. 

(5) "Department" means the department of public health and environment. 

(6) "Director" means the executive director of the department of public health and 
environment. 

(7) "Emergency" means any actual or self-perceived event which threatens life, limb, 
or well-being of an individual in such a manner that a need for immediate medical care is 
created. 

(7.5) "Emergency medical practice advisory council" or "advisory council" means the 
emergency medical practice advisory council created in section 25-3.5-206. 

(8) "Emergency medical service provider" means an individual who holds a valid 
emergency medical service provider certificate issued by the department as provided in this 
article. 

(9) "Patient" means any individual who is sick, injured, or otherwise incapacitated or 
helpless. 

(10) "Permit" means the authorization issued by the governing body of a local 
government with respect to an ambulance used or to be used to provide ambulance service 
in this state. 

(10.6) "Refresher course program" means a program establishing a course of instruc- 
tion designed to keep emergency medical service providers abreast of developments or new 
techniques in their profession, which course includes an examination administered at any 
time during or following the course to facilitate continuing evaluation of emergency 
medical service providers. 

(11) "Rescue unit" means any organized group chartered by this state as a corporation 
not for profit or otherwise existing as a nonprofit organization whose purpose is the search 
for and the rescue of lost or injured persons and includes, but is not limited to, such groups 
as search and rescue, mountain rescue, ski patrols (either volunteer or professional), law 
enforcement posses, civil defense units, or other organizations of governmental designation 
responsible for search and rescue. 

(11.5) "Service agency" means a fixed-base or mobile prehospital provider of emer- 
gency medical services that employs emergency medical service providers to render 
medical care to patients. 

(12) "Volunteer emergency medical service provider" means an emergency medical 
service provider who does not receive direct remuneration for the performance of emer- 
gency medical services. 



25-3.5-104 Health Title 25 - page 162 

Source: L. 77: Entire article added, p. 1279, § 2, effective January 1, 1978. L. 80: (1) 
and (3) amended, p. 633, § 1, effective April 8. L. 84: (10.6) added, p. 763, § 1, effective 
July 1. L. 87: (12) added, p. 1126, § 1, effective July 1. L. 94: (5) and (6) amended, p. 
2757, § 418, effective July 1. L. 2000: (3.5) and (11.5) added, p. 526, § 3, effective July 
1. L. 2005: (1) and (2) amended and (1.5) added, p. 1330, § 1, effective July 1. L. 2010: 
(7.5) added, (HB 10-1260), ch. 403, p. 1944, § 6, effective July 1. L. 2012: (8), (10.6), 
(11.5), and (12) amended, (HB 12-1059), ch. 271, p. 1437, § 20, effective July 1. 

Editor's note: Section 18 of chapter 271, Session Laws of Colorado 2012, provides that the act 
amending subsections (8), (10.6), (11.5), and (12) applies to acts committed on or after July 1, 2012. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(5) and (6), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-3.5-104. Emergency medical and trauma services advisory council - creation - 
duties. (1) (a) There is hereby created, in the department of public health and environ- 
ment, a state emergency medical and trauma services advisory council, referred to in this 
article as the "council", to be composed of thirty-two members, of whom twenty-five shall 
be appointed by the governor no later than January 1, 2001, and at least one of whom shall 
be from each of the regional emergency medical and trauma advisory council planning 
areas established in section 25-3.5-704. The other seven members shall be ex officio, 
nonvoting members. Not more than thirteen of the appointed members of the council shall 
be members of the same political party. A majority of the members shall constitute a 
quorum. The membership of the council shall reflect, as equally as possible, representation 
of urban and rural members. 

(b) The appointed members of the council shall be from the following categories: 

(I) A fire chief of a service that provides prehospital care in an urban area; 

(II) A fire chief of a service that provides prehospital care in a rural area; 

(III) An administrative representative of an urban trauma center; 

(IV) An administrative representative of a rural trauma center; 

(V) A licensed physician who is a prehospital medical director; 

(VI) A board-certified physician certified in pediatrics or a pediatric subspecialty; 

(VII) A board-certified emergency physician; 

(VIII) A flight nurse of an emergency medical service air team or unit; 

(IX) An officer or crew member of a volunteer organization who provides prehospital 
care; 

(X) An officer or employee of a public provider of prehospital care; 

(XI) An officer or employee of a private provider of prehospital care; 

(XII) A representative of a government provider of prehospital care; 

(XIII) Three county commissioners or council members from a city and county, two of 
whom shall represent rural counties and one of whom shall represent an urban county or 
city and county; 

(XIV) A board-certified surgeon providing trauma care at a level I trauma center; 

(XV) A board-certified surgeon providing trauma care at a level II trauma center; 

(XVI) A board-certified surgeon providing trauma care at a level III trauma center; 

(XVII) A board-certified neurosurgeon involved in providing trauma care at a level I or 
II trauma center; 

(XVIII) A trauma nurse coordinator; 

(XIX) A registered nurse involved in rural emergency medical and trauma services 
care; 

(XX) A regional council chair; 

(XXI) A county emergency manager; and 

(XXII) Two representatives of the general public, one from a rural area and one from 
an urban area. 

(c) Ex officio, nonvoting members of the council shall include members from the 
following categories: 

(I) A representative of the state coroners' association, as selected by the association; 



Title 25 - page 163 Emergency Medical and Trauma Services 25-3.5-104 

(II) The director of the state board for community colleges and occupational education 
or the director's designee; 

(III) The manager of the telecommunication services of the Colorado information 
technology services in the department of personnel, general support services, or the 
manager's designee; 

(IV) The executive director of the department of public health and environment or the 
director's designee; 

(V) The director of the office of transportation safety in the department of transporta- 
tion or the director's designee; 

(VI) A representative from the state sheriffs' association; and 

(VII) A representative from the Colorado state patrol. 

(2) Members of the council shall serve for terms of three years each; except that, of the 
members first appointed, eight shall be appointed for terms of one year, nine shall be 
appointed for terms of two years, and eight shall be appointed for terms of three years. 
Members of the council shall be reimbursed for actual and necessary expenses incurred in 
the actual performance of their duties. All vouchers for expenditures shall be subject to 
approval by the director. A vacancy shall be filled by appointment by the governor for the 
remainder of the unexpired term. Any appointed member who has two consecutive 
unexcused absences from meetings of the council shall be deemed to have vacated the 
membership, and the governor shall fill such vacancy as provided in this subsection (2). 

(3) The council shall meet at least quarterly at the call of the chairperson or at the 
request of any seven members. At the first meeting after the appointment of new members, 
the members shall elect a chairperson who shall serve for a term of one year. 

(4) The council shall: 

(a) Advise the department on all matters relating to emergency medical and trauma 
services programs; 

(b) Make recommendations concerning the development and implementation of state- 
wide emergency medical and trauma services; 

(c) Identify and make recommendations concerning statewide emergency medical and 
trauma service needs; 

(d) Review and approve new rules and modifications to rules existing prior to July 1 , 
2000, prior to the adoption of such rules or modifications by the state board of health; 

(e) Review and make recommendations concerning guidelines and standards for the 
delivery of emergency medical and trauma services, including: 

(I) Establishing a list of minimum equipment requirements for ambulance vehicles 
operated by an ambulance service licensed in this state and making recommendations on the 
process used by counties in the licensure of ambulance services; 

(II) Developing curricula for the training of emergency medical personnel; and 

(III) Making recommendations on the verification process used by the department to 
determine facility eligibility to receive trauma center designation; 

(f) Seek advice and counsel, up to and including the establishment of special ad hoc 
committees with other individuals, groups, organizations, or associations, when in the 
judgment of the council such is advisable to obtain necessary expertise for the purpose of 
meeting the council's responsibilities under this article. The council is authorized to 
establish special committees for the functions described in this paragraph (f). 

(g) Review and make recommendations to the department regarding the amount, 
allocation, and expenditure of funds for the development, implementation, and maintenance 
of the statewide emergency medical and trauma system. 

Source: L. 77: Entire article added, p. 1280, § 2, effective January 1, 1978. L. 82: (1) 
amended, p. 356, § 17, effective April 30. L. 83: (1) amended, p. 889, § 4, effective July 
1. L. 84: (4)(j), (4)(k), and (5) added, p. 763, §§ 2, 3, effective July 1. L. 85: (1) amended, 
p. 881, § 1, effective July 1. L. 86: (6) added, p. 420, § 42, effective March 26. L. 89: (1) 
amended and (6) repealed, pp. 1146, 1147, §§ 2, 3, effective April 6. L. 91: (1) amended, 
p. 1068, § 40, effective July 1. L. 92: (1) amended, p. 1043, § 9, effective March 12. 



25-3.5-104.3 Health Title 25 - page 164 

L. 94: (1) amended, p. 2757, § 419, effective July 1. L. 95: (1), (2), (3), IP(4), (4)(f), 
(4)(g), and (5) amended, p. 1350, § 2, effective July 1. L. 2000: Entire section R&RE, p. 
526, § 4, effective January 1, 2001. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-3.5-104.3. State trauma advisory council - duties. (Repealed) 

Source: L. 95: Entire section added, p. 1347, § 1, effective July 1. L. 96: (l)(c)(IV) 
amended, p. 1541, § 128, effective June 1. L. 2000: Entire section repealed, p. 547, § 26, 
effective January 1, 2001. 

25-3.5-104.5. Joint advisory council - duties. (Repealed) 

Source: L. 95: Entire section added, p. 1347, § 1, effective July 1. L. 2000: Entire 
section repealed, p. 547, § 26, effective January 1, 2001. 

25-3.5-105. Rules and regulations. All rules and regulations adopted pursuant to the 
provisions of this article shall be adopted in accordance with the provisions of article 4 of 
title 24, C.R.S. 

Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. 

25-3.5-106. Local standards - uninterrupted service. (1) Nothing in this article 
shall be construed to prevent a municipality or special district from adopting standards more 
stringent than those provided in this article. 

(2) In no event shall the providing of service to sick or injured persons be interrupted, 
between point of origin and point of destination, when an ambulance run traverses one or 
more jurisdictions whose adopted standards are more stringent than those adopted in the 
jurisdiction where such ambulance run originates. 

Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. 

ANNOTATION 

This section does not refer to licensing of Arvada, 42 Colo. App. 491, 601 P.2d 639 
ambulances. DuHamel v. People ex rel. City of (1979). 

25-3.5-107. Religious exception. Nothing in this article or the rules and regulations 
adopted pursuant to this article shall be construed to authorize any medical treatment or 
transportation to any hospital or other emergency care center of an adult who objects thereto 
on religious grounds and signs a written waiver to that effect. 

Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. 

PART 2 
TREATMENT SUBSYSTEM 

25-3.5-201. Training programs. (1) The department shall design and establish spe- 
cialized curricula for personnel who respond routinely to emergencies. The board of county 
commissioners may select from the various curricula available those courses meeting the 
minimum requirements established by said board. 

(2) The department shall distribute the curricula and teaching aids to training institu- 
tions and hospitals upon request from a recognized training group or hospital. If a county 



Title 25 - page 165 Emergency Medical and Trauma Services 25-3.5-203 

is unable to arrange for necessary training programs, the department shall arrange a training 
program within the immediate vicinity of the agency requesting the program. The depart- 
ment shall issue emergency medical service provider certificates in accordance with section 
25-3.5-203 (1) and may issue certificates of successful course completion to those indi- 
viduals who successfully complete other emergency medical services training programs of 
the department. The programs may provide for the training of emergency medical dispatch- 
ers, emergency medical services instructors, emergency medical services coordinators, and 
other personnel who provide emergency medical services. The receipt of the certificate of 
course completion is not deemed state licensure, approval, or a determination of compe- 
tency. 

Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. L. 92: (2) 
amended, p. 1143, § 1, effective May 29. L. 2010: (1) amended, (HB 10-1260), ch. 403, 
p. 1944, § 7, effective July 1. L. 2012: (2) amended, (HB 12-1059), ch. 271, p. 1428, § 2, 
effective July 1. 

Editor's note: Section 18 of chapter 271, Session Laws of Colorado 2012, provides that the act 
amending subsecdon (2) applies to acts committed on or after July 1, 2012. 

25-3.5-202. Personnel - basic requirements. Emergency medical personnel employed 
or utilized in connection with an ambulance service shall meet the qualifications estab- 
lished, by resolution, by the board of county commissioners of the county in which the 
ambulance is based in order to be certified. For ambulance drivers, the minimum require- 
ments include the possession of a valid driver's license and other requirements established 
by the board by rule under section 25-3.5-308; for any person responsible for providing 
direct emergency medical care and treatment to patients transported in an ambulance, the 
minimum requirement is possession of an emergency medical service provider certificate 
issued by the department. In the case of an emergency in an ambulance service area where 
no person possessing the qualifications required by this section is present or available to 
respond to a call for the emergency transportation of patients by ambulance, any person may 
operate the ambulance to transport any sick, injured, or otherwise incapacitated or helpless 
person in order to stabilize the medical condition of the person pending the availability of 
medical care. 

Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. L. 78: 
Entire section amended, p. 409, § 1, effective April 4. L. 79: Entire section amended, p. 
1011, § 1, effective July 1. L. 84: Entire section amended, p. 764, § 4, effective July 1. 
L. 2000: Entire section amended, p. 529, § 5, effective July 1. L. 2012: Entire section 
amended, (HB 12-1059), ch. 271, p. 1428, § 3, effective July 1. 

Editor's note: Section 18 of chapter 271, Session Laws of Colorado 2012, provides that the act 
amending this section applies to acts committed on or after July 1, 2012. 

25-3.5-203. Emergency medical service providers - certification - renewal of cer- 
tificate - duties of department - rules - criminal history record checks. 

(1) (a) Repealed. 

(a.5) The executive director or chief medical officer shall regulate the acts emergency 
medical service providers are authorized to perform subject to the medical direction of a 
licensed physician. The executive director or chief medical officer, after considering the 
advice and recommendations of the advisory council, shall adopt and revise rules, as 
necessary, regarding the regulation of emergency medical service providers and their duties 
and functions. 

(b) The department shall certify emergency medical service providers. The board shall 
adopt rules for the certification of emergency medical service providers. The rules must 
include the following: 



25-3.5-203 Health Title 25 - page 166 

(1) A statement that a certificate is valid for a period of three years after the date of 
issuance; 

(II) A statement that the certificate shall be renewable at its expiration upon the 
certificate holder's satisfactory completion of the training requirements established pursuant 
to subsection (2) of this section; 

(III) Provisions governing the use of results of national and state criminal history record 
checks by the department to determine the action to take on a certification application 
pursuant to subsection (4) of this section. Notwithstanding the provisions of section 
24-5-101, C.R.S., these provisions shall allow the department to consider whether the 
applicant has been convicted of a felony or misdemeanor involving moral turpitude and the 
pertinent circumstances connected with the conviction and to make a determination whether 
any such conviction disqualifies the applicant from certification. 

(IV) Disciplinary sanctions, which shall include provisions for the denial, revocation, 
and suspension of certificates and the suspension and probation of certificate holders; and 

(V) An appeals process pursuant to sections 24-4-104 and 24-4-105, C.R.S., that is 
applicable to department decisions in connection with certifications and sanctions. 

(c) (I) The department may issue a provisional certification to an applicant for certi- 
fication as an emergency medical service provider who requests issuance of a provisional 
certification and who pays any fee authorized under rules adopted by the board. A 
provisional certification is valid for not more than ninety days. 

(II) The department shall not issue a provisional certification unless the applicant 
satisfies the requirements for certification in accordance with this section and rules adopted 
by the board under this subsection (1). If the department finds that an emergency medical 
service provider that has received a provisional certification has violated any requirements 
for certification, the department may impose disciplinary sanctions under subparagraph (IV) 
of paragraph (b) of this subsection (1). 

(III) The department may issue a provisional certification to an applicant whose 
fingerprint-based criminal history record check has not yet been completed. The department 
shall require the applicant to submit a name-based criminal history record check prior to 
issuing a provisional certification. 

(IV) The board shall adopt rules as necessary to implement this paragraph (c), including 
rules establishing a fee to be charged to applicants seeking a provisional certification. Any 
fee collected for a provisional certification shall be deposited in the emergency medical 
services account created in section 25-3.5-603. 

(d) (I) The department shall exempt certified emergency medical service providers 
who have been called to federally funded active duty for more than one hundred twenty 
days to serve in a war, emergency, or contingency from the payment of certification fees and 
from continuing education or professional competency requirements of this article for a 
renewal date during the service or the six months after the completion of service. 

(II) Upon presentation of satisfactory evidence by an applicant for renewal of certifi- 
cation, the department may accept continuing medical education, training, or service 
completed by an individual as a member of the armed forces or reserves of the United 
States, the National Guard of any state, the military reserves of any state, or the naval militia 
of any state toward the qualifications to renew the individual's certification. 

(III) An individual serving in the armed services of the United States or the spouse of 
the individual may apply for certification under this article while stationed within this state. 
The individual or spouse is exempt from the initial certification requirements in this article, 
except for those in subsection (4) of this section if the person holds a valid certificate or 
license to provide emergency medical services from another state, the certificate or license 
is current, and the person is in good standing. 

(IV) The board shall promulgate rules to implement this paragraph (d), including the 
criteria and evidence for acceptable continuing medical education and training or service. 

(2) The council shall advise the department and the board in establishing the training 
requirements for certificate renewal. Such training requirements shall consist of not more 
than fifty classroom hours and not less than thirty-six classroom hours. 

(3) Repealed. 



Title 25 - page 167 Emergency Medical and Trauma Services 25-3.5-203 

(4) (a) The department may, with reasonable cause, acquire a fingerprint-based crim- 
inal history record check from the Colorado bureau of investigation to investigate the holder 
of or applicant for an emergency medical service provider certificate. The department may 
acquire a name-based criminal history record check for a certificate holder or an applicant 
who has twice submitted to a fingerprint-based criminal history record check and whose 
fingerprints are unclassifiable. 

(b) (I) Any government entity that employs a person as or allows a person to volunteer 
as an emergency medical service provider in a position requiring direct contact with patients 
shall require all volunteer and employed emergency medical service providers, who have 
lived in the state for three years or less at the time of the initial certification or certification 
renewal, to submit to a federal bureau of investigation fingerprint-based national criminal 
history record check to determine eligibility for employment. Each emergency medical 
service provider required to submit to a federal bureau of investigation fingerprint-based 
national criminal history record check shall obtain a complete set of fingerprints taken by 
a local law enforcement agency or another entity designated by the department. The local 
law enforcement agency or other designated entity that took the fingerprints shall transmit 
them to the Colorado bureau of investigation, which shall in turn forward them to the 
federal bureau of investigation for a national criminal history record check. The department 
or other authorized government entity is the authorized agency to receive and disseminate 
information regarding the result of a national criminal history record check. Each entity 
handling the national criminal history record check shall comply with Pub.L. 92-544, as 
amended. Each government entity acting as the authorized recipient of the result of a 
national criminal history record check shall forward the result of the initial national criminal 
history record check and any subsequent notification of activity on the record to the 
department to determine the individual's eligibility for initial certification or certification 
renewal. 

(II) Notwithstanding the provisions of subparagraph (I) of this paragraph (b), the 
government entity may acquire a name-based criminal history record check for an individ- 
ual who has twice submitted to a fingerprint-based criminal history record check and whose 
fingerprints are unclassifiable. 

(c) (I) (A) A government entity or private, not-for-profit, or for-profit organization that 
employs a person or allows a person to volunteer as an emergency medical service provider 
in a position requiring direct contact with patients shall require all volunteer and employed 
emergency medical service providers, who have lived in the state for more than three years 
at the time of initial certification or certification renewal, to submit to a fingerprint-based 
criminal history record check by the Colorado bureau of investigation to determine 
eligibility for employment. The organization shall forward the result of the criminal history 
record check and any subsequent notification of activity on the record to the department to 
determine eligibility for initial certification or certification renewal. 

(B) Notwithstanding the provisions of sub-subparagraph (A) of this subparagraph (I), 
the government entity or private, not-for-profit, or for-profit organization may acquire a 
name-based criminal history record check for an individual who has twice submitted to a 
fingerprint-based criminal history record check and whose fingerprints are unclassifiable. 

(II) Notwithstanding the provisions of subparagraph (I) of this paragraph (c), if a person 
submitted to a fingerprint-based criminal history record check at the time of initial 
certification or certification renewal, the person shall not be required to submit to a 
subsequent fingerprint-based criminal history record check. 

(d) (I) If an applicant for initial certification or certification renewal is not employed at 
the time of application, the department shall require the applicant to submit to a fingerprint- 
based criminal history record check by the Colorado bureau of investigation as defined in 
rule by the board of health, if the applicant has lived in the state for more than three years; 
except that the department may acquire a state name-based criminal history record check for 
an applicant who has twice submitted to a fingerprint-based criminal history record check 
and whose fingerprints are unclassifiable. 

(II) Notwithstanding the provisions of subparagraph (I) of this paragraph (d), if a 
person submitted to a fingerprint-based criminal history record check at the time of initial 



25-3.5-204 Health Title 25 - page 168 

certification or certification renewal, the person shall not be required to submit to a 
subsequent fingerprint-based criminal history record check. 

(e) If the applicant is not employed or is employed by a nongovernmental entity at the 
time of application and has lived in the state for three years or less, the department shall 
require the applicant to submit to a federal bureau of investigation fingerprint-based 
national criminal history record check; except that the department may acquire a national 
name-based criminal history record check for an applicant who has twice submitted to a 
fingerprint-based criminal history record check and whose fingerprints are unclassifiable. 
The department shall be the authorized agency to receive and disseminate information 
regarding the result of any national criminal history record check. Any such national 
criminal history record check shall be handled in accordance with Pub.L. 92-544, as 
amended. 

(5) For the purposes of this article, unless the context otherwise requires, "medical 
direction" includes, but is not limited to, the following: 

(a) Approval of the medical components of treatment protocols and appropriate 
prearrival instructions; 

(b) Routine review of program performance and maintenance of active involvement in 
quality improvement activities, including access to dispatch tapes as necessary for the 
evaluation of procedures; 

(c) Authority to recommend appropriate changes to protocols for the improvement of 
patient care; and 

(d) Provide oversight for the ongoing education, training, and quality assurance for 
providers of emergency care. 

Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. L. 84: 
Entire section amended, p. 764, § 5, effective July 1. L. 85: (1) amended, p. 524, § 16, 
effective July 1. L. 87: (1) amended and (3) added, p. 1126, § 2, effective July 1. L. 89: 
(1) amended and (3) repealed, p. 1152, §§ 3, 5, effective July 1. L. 94: (1) amended, p. 
2758, § 420, effective July 1. L. 2000: (1) amended and (4) and (5) added, p. 529, § 6, 
effective July 1. L. 2001: (1), (2), and (4) amended, p. 1144, § 1, effective June 5. 
L. 2003: (l)(b)(III) and (4) amended, p. 1662, § 1, effective May 14. L. 2007: (4)(a), 
(4)(b), (4)(c)(I), (4)(d)(I), and (4)(e) amended, p. 637, § 1, effective April 26. L. 2009: 
(l)(c) added, (HB 09-1275), ch. 278, p. 1244, § 1, effective May 19. L. 2010: (l)(a) 
amended and (l)(a.5) added, (HB 10-1260), ch. 403, p. 1944, § 8, effective July 1. 
L. 2012: (l)(a.5), IP(l)(b), (l)(c)(l), (l)(c)(II), (4)(a), (4)(b)(I), and (4)(c)(I)(A) amended 
and (l)(d) added, (HB 12-1059), ch. 271, p. 1428, § 4, effective July 1. 

Editor's note: (1) Subsection (l)(a)(II) provided for the repeal of subsection (l)(a), effective 
January 1, 2011. (See L. 2010, p. 1944.) 

(2) Secdon 18 of chapter 271, Session Laws of Colorado 2012, provides that the act amending 
subsecfion (l)(a.5), the introductory portion to subsection (l)(b), subsections (l)(c)(I), (l)(c)(II), 
(4)(a), (4)(b)(I), and (4)(c)(I)(A) and adding subsection (l)(d) applies to acts committed on or after 
July 1, 2012. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), see secUon 1 of chapter 345, Session Laws of Colorado 1994. 

25-3.5-204. Emergency medical services for children. (1) The department is au- 
thorized to establish a program to improve the quality of emergency care to pediatric 
patients throughout the state, including a component to address public awareness of 
pediatric emergencies and injury prevention. 

(2) The department is authorized to receive contributions, grants, donations, or funds 
from any public or private entity to be expended for the program authorized pursuant to this 
section. 

Source: L. 95: Entire section added, p. 1361, §4, effective July 1. 



Title 25 - page 169 Emergency Medical and Trauma Services 25-3.5-206 

25-3.5-205. Emergency medical service providers - investigation - discipline. 

(1) (a) The department may administer oaths, take affirmations of witnesses, and issue 
subpoenas to compel the attendance of witnesses and the production of all relevant records 
and documents to investigate alleged misconduct by certified emergency medical service 
providers. 

(b) Upon failure of a witness to comply with a subpoena, the department may apply to 
a district court for an order requiring the person to appear before the department or an 
administrative law judge, to produce the relevant records or documents, or to give testimony 
or evidence touching the matter under investigation or in question. When seeking an order, 
the department shall apply to the district court of the county in which the subpoenaed person 
resides or conducts business. The court may punish such failure as a contempt of court. 

(2) An emergency medical service provider, the employer of an emergency medical 
service provider, a medical director, and a physician providing medical direction of an 
emergency medical service provider shall report to the department any misconduct that is 
known or reasonably believed by the person to have occurred. 

(3) A person acting as a witness or consultant to the department, a witness testifying, 
and a person or employer who reports misconduct to the department under this section shall 
be immune from liability in any civil action brought for acts occurring while testifying, 
producing evidence, or reporting misconduct under this section if such individual or 
employer was acting in good faith and with a reasonable belief of the facts. A person or 
employer participating in good faith in an investigation or an administrative proceeding 
pursuant to this section shall be immune from any civil or criminal liability that may result 
from such participation. 

(4) All records, documents, testimony, or evidence obtained under this section shall 
remain confidential except to the extent necessary to support the administrative action taken 
by the department, to refer the matter to another regulatory agency, or to refer the matter to 
a law enforcement agency for criminal prosecution. 

(5) For the purposes of this section: 

(a) "Medical director" means a physician who supervises certified emergency medical 
service providers consistent with the rules adopted by the executive director or chief 
medical officer, as applicable, under section 25-3.5-206. 

(b) "Misconduct" means an activity meeting the good cause for disciplinary sanctions 
standard, as defined by the board. 

Source: L. 2005: Entire section added, p. 875, § 1, effective August 8. L. 2010: (5)(a) 
amended, (HB 10-1260), ch. 403, p. 1945, § 9, effective July 1. L. 2012: (l)(a), (2), and 
(5)(a) amended, (HB 12-1059), ch. 271, p. 1430, § 5, effective July 1. 

Editor's note: Secdon 18 of chapter 271, Session Laws of Colorado 2012, provides that the act 
amending subsecdons (l)(a), (2), and (5)(a) applies to acts committed on or after July 1, 2012. 

25-3.5-206. Emergency medical practice advisory council - creation - powers and 
duties - emergency medical service provider scope of practice rules. (1) There is 
hereby created within the department, as a type 2 entity under the direction of the executive 
director of the department, the emergency medical pracdce advisory council, referred to in 
this part 2 as the "advisory council". The advisory council is responsible for advising the 
department regarding the appropriate scope of practice for emergency medical service 
providers certified under section 25-3.5-203. 

(2) (a) The emergency medical practice advisory council consists of the following 
eleven members: 

(I) Eight voting members appointed by the governor as follows: 

(A) Two physicians licensed in good standing in Colorado who are actively serving as 
emergency medical service medical directors and are practicing in rural or frontier counties; 

(B) Two physicians licensed in good standing in Colorado who are actively serving as 
emergency medical service medical directors and are practicing in urban counties; 

(C) One physician licensed in good standing in Colorado who is actively serving as an 
emergency medical service medical director in any area of the state; 



25-3.5-206 Health Title 25 - page 170 

(D) One emergency medical service provider certified at an advanced life support level 
who is actively involved in the provision of emergency medical services; 

(E) One emergency medical service provider certified at a basic life support level who 
is actively involved in the provision of emergency medical services; and 

(F) One emergency medical service provider certified at any level who is actively 
involved in the provision of emergency medical services; 

(II) One voting member who, as of July 1, 2010, is a member of the state emergency 
medical and trauma services advisory council, appointed by the executive director of the 
department; and 

(III) Two nonvoting ex officio members appointed by the executive director of the 
department. 

(b) Members of the advisory council shall serve four-year terms; except that, of the 
members initially appointed to the advisory council by the governor, four members shall 
serve three-year terms. A vacancy on the advisory council shall be filled by appointment by 
the appointing authority for that vacant position for the remainder of the unexpired term. 
Members serve at the pleasure of the appointing authority and continue in office until the 
member's successor is appointed. 

(c) Members of the advisory council shall serve without compensation but shall be 
reimbursed from the emergency medical services account, created in section 25-3.5-603, for 
their actual and necessary travel expenses incurred in the performance of their duties under 
this article. 

(d) The advisory council shall elect a chair and vice-chair from its members. 

(e) The advisory council shall meet at least quarterly and more frequently as necessary 
to fulfill its obhgations. 

(f) The department shall provide staff support to the advisory council. 

(g) As used in this subsection (2), "licensed in good standing" means that the physician 
holds a current, valid license to practice medicine in Colorado that is not subject to any 
restrictions. 

(3) The advisory council shall provide general technical expertise on matters related to 
the provision of patient care by emergency medical service providers and shall advise or 
make recommendations to the department in the following areas: 

(a) The acts and medications that certified emergency medical service providers at each 
level of certification are authorized to perform or administer under the direction of a 
physician medical director; 

(b) Requests for waivers to the scope of practice rules adopted pursuant to this section 
and section 25-3.5-203 (1) (a.5); 

(c) Modifications to emergency medical service provider certification levels and capa- 
bilities; and 

(d) Criteria for physicians to serve as emergency medical service medical directors. 

(4) (a) The executive director or, if the executive director is not a physician, the chief 
medical officer shall adopt rules in accordance with article 4 of title 24, C.R.S., concerning 
the scope of practice of emergency medical service providers for prehospital care. The rules 
must include the following: 

(I) Allowable acts for each level of emergency medical service provider certification 
and the medications that each level of emergency medical service provider certification can 
administer; 

(II) Defining the physician medical direction required for appropriate oversight of an 
emergency medical service provider by an emergency medical services medical director; 

(III) Criteria for requests to waive the scope of practice rules and the conditions for 
such waivers; and 

(IV) Minimum standards for physicians to be emergency medical services medical 
directors. 

(b) Rules adopted pursuant to this subsection (4) supersede any rules of the Colorado 
medical board regarding the matters set forth in this subsection (4). 



Title 25 - page 171 Emergency Medical and Trauma Services 25-3.5-301 

Source: L. 2010: Entire section added, (HB 10-1260), ch. 403, p. 1945, § 10, effective 
July 1. L. 2012: (1), IP(2)(a), (2)(a)(I)(D), (2)(a)(I)(E), (2)(a)(I)(F), IP(3), (3)(a), (3)(c), 
IP(4)(a), (4)(a)(I), and (4)(a)(II) amended, (HB 12-1059), ch. 271, p. 1431, § 6, effective 
July 1. 

Editor's note: Section 18 of chapter 271, Session Laws of Colorado 2012, provides that the act 
amending subsection (1), the introductory portion to subsection (2)(a), subsections (2)(a)(I)(D), 
(2)(a)(I)(E), and (2)(a)(I)(F), the introductory portion to subsection (3), subsections (3)(a) and (3)(c), 
the introductory portion to subsection (4)(a), and subsections (4)(a)(I) and (4)(a)(II) applies to acts 
committed on or after July 1, 2012. 

PART 3 

TRANSPORTATION SUBSYSTEM 

25-3.5-301. License required - exceptions. (1) After January 1, 1978, no person 
shall provide ambulance service publicly or privately in this state unless that person holds 
a valid license to do so issued by the board of county commissioners of the county in which 
the ambulance service is based, except as provided in subsection (5) of this section. 
Licenses, permits, and renewals thereof, issued under this part 3, shall require the payment 
of fees in amounts to be determined by the board to reflect the direct and indirect costs 
incurred by the department in implementing such licensure, but the board may waive 
payment of such fees for ambulance services operated by municipalities or special districts. 

(2) (a) (I) Each ambulance operated by an ambulance service shall be issued a permit 
and, in order to be approved, shall bear evidence that its equipment meets or is equivalent 
to the minimum requirements set forth in the minimum equipment list established by the 
council and approved by the state board of health. The board of county commissioners of 
any county may impose by resolution additional requirements for ambulances based in such 
county. 

(II) Repealed, 
(a.l) Repealed. 

(b) The council shall make available to the board of county commissioners guidelines 
for ambulance design criteria for use in developing standards for vehicle replacement. 

(3) No patient shall be transported in an ambulance in this state after January 1, 1978, 
unless there are two or more individuals, including the driver, present and authorized to 
operate said ambulance except under unusual conditions when only one authorized person 
is available. 

(4) (Deleted by amendment, L. 2002, p. 696, § 1, effective May 29, 2002.) 

(5) The provisions of subsections (1) to (3) of this section shall not apply to the 
following: 

(a) The exceptional emergency use of a privately or publicly owned vehicle, including 
search and rescue unit vehicles, or aircraft not ordinarily used in the formal act of 
transporting patients; 

(b) A vehicle rendering services as an ambulance in case of a major catastrophe or 
emergency when ambulances with permits based in the localities of the catastrophe or 
emergency are insufficient to render the services required; 

(c) Ambulances based outside this state which are transporting a patient in Colorado; 

(d) Vehicles used or designed for the scheduled transportation of convalescent patients, 
individuals with disabilities, or persons who would not be expected to require skilled 
treatment or care while in the vehicle; 

(e) Vehicles used solely for the transportation of intoxicated persons or persons 
incapacitated by alcohol as defined in section 27-81-102, C.R.S., but who are not otherwise 
disabled or seriously injured and who would not be expected to require skilled treatment or 
care while in the vehicle. 

Source: L. 77: Entire article added, p. 1282, § 2, effective January 1, 1978. L. 81: 
(2)(a) amended, p. 1944, § 4, effective July 1; (2)(a.l) added, p. 1951, § 18, effective July 



25-3.5-302 Health Title 25 - page 172 

1, 1984. L. 84: (2)(a)(I) amended, p. 1125, § 45, effective July 1; (2)(a)(II) and (2)(a.l) 
repealed, p. 1080, § 1, effective July 1; (2)(a.l)(I) amended, p. 765, § 6, effective July 1. 
L. 93: (5)(d) amended, p. 1664, § 73, effective July 1. L. 2002: (1) and (4) amended, p. 
696, § 1, effective May 29. L. 2010: (5)(e) amended, (SB 10-175), ch. 188, p. 799, § 62, 
effective April 29. 

ANNOTATION 

Limitation on entities which may license To subject ambulance companies to au- 

ambulances. Since the general assembly has thority of two jurisdictions is contrary to 

indicated a coordinated system of emergency purpose of this act because it fragments the 
medical care to be of statewide concern and has coordinated system and could reduce the avail- 
provided a comprehensive statutory scheme to ability of service. DuHamel v. People ex rel. 
regulate the field, governmental entities other City of Arvada,42Colo. App. 491, 601 P.2d639 
than those provided in this section may not (1979). 
license ambulances. DuHamel v. People ex rel. 
City of Arvada, 42 Colo. App. 491, 601 P.2d 639 
(1979). 

25-3.5-302. Issuance of licenses and permits - term - requirements. (1) (a) After 
receipt of an original application for a license to provide ambulance service, the board of 
county commissioners shall review the application and the applicant's record and provide 
for the inspection of equipment to determine compliance with the provisions of this part 3. 

(b) The board of county commissioners shall issue a license to the applicant to provide 
ambulance service and a permit for each ambulance used, both of which shall be valid for 
twelve months following the date of issue, upon a finding that the applicant's staff, vehicle, 
and equipment comply with the provisions of this part 3 and any other requirement 
established by said board. 

(2) Any such license or permit, unless revoked by the board of county commissioners, 
may be renewed by filing an application as in the case of an original application for such 
license or permit. Applications for renewal shall be filed annually but not less than thirty 
days before the date the license or permit expires. 

(3) No license or permit issued pursuant to this section shall be sold, assigned, or 
otherwise transferred. 

Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. 

ANNOTATION 

Applied in DuHamel v. People ex rel. City of 
Arvada, 42 Colo. App. 491, 601 P2d 639 
(1979). 

25-3.5-303. Vehicular liability insurance required. No ambulance shall operate in 
this state unless it is covered by a complying policy as defined in section 10-4-601 (2), 
C.R.S. 

Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. L. 2006: 
Entire section amended, p. 1504, § 45, effective June 1. 

25-3.5-304. Suspension - revocation - hearings. (1) Upon a determination by the 
board of county commissioners that any person has violated or failed to comply with any 
provisions of this part 3, the board may temporarily suspend, for a period not to exceed 
thirty days, any license or permit issued pursuant to this part 3. The licensee shall receive 
written notice of such temporary suspension, and a hearing shall be held no later than ten 
days after such temporary suspension. After such hearing, the board may suspend any 
license or permit, issued pursuant to this part 3, for any portion of or for the remainder of 



Title 25 - page 173 Emergency Medical and Trauma Services 25-3.5-307 

its life. At the end of such period, the person whose license or permit was suspended may 
apply for a new license or permit as in the case of an original application. 

(2) Upon a second violation or failure to comply with any provision of this part 3 by 
any licensee, the board of county commissioners may permanently revoke such license or 
permit. 

Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. 

25-3.5-305. Alleged negligence. (1) In any legal action filed against a person who 
has been issued a license pursuant to this part 3 in which it is alleged that the plaintiff's 
injury, illness, or incapacity was exacerbated or that he was otherwise injured by the 
negligence of the licensee, an act of negligence shall not be presumed based on the fact of 
the allegation. 

(2) In the event a judgment is entered against any such licensee, he shall, within thirty 
days thereof, file a copy of the findings of fact, conclusions of law, and order in such case 
with the clerk and recorder of the county issuing the license. Said board shall take note of 
such judgment for purposes of investigation and appropriate action if a violation of this part 
3 is present. Any and all complaints received directly by said board shall be subject to 
review. 

Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. 

25-3.5-306. Violation - penalty. Any person who violates any provision of this part 3 
commits a class 3 misdemeanor and shall be punished as provided in section 18-1.3-501, 
C.R.S. 

Source: L. 77: Entire article added, p. 1284, § 2, effective January 1, 1978. L. 2002: 
Entire section amended, p. 1536, § 264, effective October 1. 

Cross references: For the legislative declaration contained in the 2002 act amending this section, 
see section 1 of chapter 318, Session Laws of Colorado 2002. 

25-3.5-307. Licensure of fixed-wing and rotor-wing air ambulances - cash fund 
created - rules. (1) (a) Except as provided in paragraph (b) of this subsection (1), prior 
to beginning air ambulance operations in this state, all fixed-wing and rotor-wing air 
ambulance services shall be licensed by the department. Successful completion of an 
accreditation process as established and updated by the commission on accreditation of 
medical transport systems (CAMTS) or a successor organization is required for full 
licensure and renewal of such license by the department for all fixed-wing and rotor-wing 
air ambulance services. The department may issue a conditional license to an air ambulance 
service that has not completed CAMTS accreditation if the service is actively working 
toward CAMTS accreditation. An air ambulance service that receives a conditional license 
shall complete its CAMTS accreditation within two years after issuance of the conditional 
license. If an air ambulance service to which a conditional license has been issued fails to 
complete the CAMTS accreditation process within two years after issuance of the initial 
conditional license, the conditional license shall be revoked, and the air ambulance service 
shall not be issued any type of license until it successfully completes the CAMTS 
accreditation process. 

(b) Upon a showing of exigent circumstances, as defined by the board, the department 
may authorize an unlicensed air ambulance service to provide a particular transport. 

(c) The board shall promulgate rules specifying additional licensure requirements, 
establishing a reasonable fee for licensure, defining exigent circumstances for purposes of 
the exception in paragraph (b) of this subsection (1), and specifying the procedure and 
grounds for the suspension, revocation, or denial of a license. Such rules shall include the 
process used to investigate complaints against an air ambulance service and procedures for 
data collection and reporting to the department by an air ambulance service; except that 



25-3.5-308 Health Title 25 - page 174 

complaints that are related to the requirements of CAMTS or a successor organization shall 
be referred to CAMTS or such successor organization for investigation. The department 
shall consider the results of such investigations in making licensure decisions concerning air 
ambulance services. 

(2) (a) The board shall establish the amount of the licensure fee to reflect the direct and 
indirect costs incurred by the department in implementing such licensure. The department 
shall transmit all fees collected pursuant to this section to the state treasurer who shall credit 
the same to the fixed-wing and rotary-wing ambulances cash fund, which fund is hereby 
created in the state treasury. 

(b) Any interest derived from the deposit and investment of moneys in the fixed-wing 
and rotary-wing ambulances cash fund shall be credited to such fund. Any unexpended or 
unencumbered moneys remaining in such fund at the end of any fiscal year shall remain in 
the fund and shall not revert or be transferred to the general fund or any other fund of the 
state. Moneys in such fund shall be subject to annual appropriation by the general assembly 
to the department for the costs incurred by the department in implementing this section. 

Source: L. 2002: Entire section added, p. 697, § 2, effective May 29. L. 2005: (1) 
amended, p. 1331, § 2, effective July 1. L. 2007: (1) amended, p. 380, § 1, effective April 

2. 

25-3.5-308. Rules. ( 1 ) The board shall adopt rules establishing the minimum require- 
ments for ground ambulance service licensing, including but not limited to: 

(a) Minimum equipment to be carried on an ambulance pursuant to section 25-3.5-104; 

(b) Staffing requirements for ambulances as required in section 25-3.5-104; 

(c) Medical oversight and quality improvement of ambulance services pursuant to 
section 25-3.5-704 (2) (h); 

(d) The process used to investigate complaints against an ambulance service; and 

(e) Data collection and reporting to the department by an ambulance service. 

Source: L. 2002: Entire section added, p. 697, § 2, effective May 29. L. 2005: IP(1) 
amended, p. 1331, § 3, effective July 1. 

PART 4 

TELECOMMUNICATIONS SUBSYSTEM 

25-3.5-401. Responsibility for coordination. (1) The telecommunications subsys- 
tem shall be used to maintain effective interface with the other components of the system, 
which shall include but not be limited to the following: 

(a) To dispatch the ambulance; 

(b) To maintain contact while en route to the scene of the emergency; 

(c) To provide for triage at the scene of the emergency; 

(d) To provide for treatment while en route to the primary emergency care center; 

(e) To arrange for transfer to advanced emergency care centers. 

(2) (a) The department of personnel, in consultation with the office of information 
technology created in the office of the governor, shall coordinate the telecommunications 
subsystem with the existing state telecommunications network to the extent possible. 

(b) Repealed. 

Source: L. 77: Entire article added, p. 1284, § 2, effecfive January 1, 1978. L. 81: IP(1) 
amended, p. 2028, § 29, effective June 7; (2)(b) repealed, p. 2028, § 31, effecfive July 14. 
L. 83: (2)(a) amended, p. 889, § 5, effective July 1. L. 84: IP(1) amended, p. 1121, § 26, 
effecfive June 7. L. 95: (2)(a) amended, p. 663, § 96, effecfive July 1. L. 2001: (2)(a) 
amended, p. 125, § 6, effective March 23. L. 2006: (2)(a) amended, p. 1736, § 25, 
effective June 6. 



Title 25 - page 175 Emergency Medical and Trauma Services 25-3.5-601 

Cross references: (1) For provisions concerning telecommunications coordination within state 
government, see part 5 of article 37.5 of tide 24; for the state telecommunications network, see 
§ 24-33.5-223. 

(2) For the legislative declaration contained in the 1995 act amending subsection (2)(a), see 
section 112 of chapter 167, Session Laws of Colorado 1995. 

25-3.5-402. Local government participation. The department of personnel shall 
consult with local government entities to ensure that provision is made for their entry into 
the statewide telecommunications subsystem and that their present resources are being fully 
utilized. 

Source: L. 77: Entire article added, p. 1284, § 2, effective January 1, 1978. L. 83: 
Entire section amended, p. 889, § 6, effective July 1. L. 96: Entire section amended, p. 
1541, § 129, effective June 1. 

25-3.5-403. Poison information center - state funding. (Repealed) 

Source: L. 83: Entire section added, p. 1056, § 3, effective July 1. L. 94: Entire section 
amended, p. 1665, § 2, effective July 1. 

Editor's note: Subsection (3) provided for the repeal of this section, effective July 1, 1995. (See 
L. 94, p. 1665.) 

PART 5 

DOCUMENTATION SUBSYSTEM 

25-3.5-501. Records. (1) Each ambulance service shall prepare and transmit copies 
of uniform and standardized records, as specified by regulation adopted by the department, 
concerning the transportation and treatment of patients in order to evaluate the performance 
of the emergency medical services system and to plan systematically for improvements in 
said system at all levels. 

(2) The record forms adopted by the department may distinguish between rural 
ambulance service and urban ambulance service and between mobile intensive care units 
and basic ambulance service. 

Source: L. 77: Entire article added, p. 1284, § 2, effective January 1, 1978. L. 78: 
Entire section amended, p. 270, § 84, effective May 23. 

25-3.5-502. Forms and reports. The department shall provide the necessary forms and 
copies of quarterly statistical report forms for local and state evaluation of ambulance 
service unless specifically exempted by the board of county commissioners of a particular 
county for that county. 

Source: L. 77: Entire article added, p. 1285, § 2, effective January 1, 1978. L. 78: 
Entire section amended, p. 271, § 85, effective May 23. 

PART 6 

LOCAL EMERGENCY MEDICAL SERVICES 

25-3.5-601. Legislative declaration. (1) The general assembly recognizes that an 
efficient and reliable statewide emergency medical and trauma network would serve not 
only to promote the health, safety, and welfare of Colorado residents, but would also, by 
increasing safety throughout the state, indirectly serve to facilitate tourism and economic 
development in the state. 



25-3.5-602 Health Title 25 - page 176 

(2) The general assembly also finds that accident victims are often transported over 
state highways and that an improved response to accidents through an efficient and reliable 
statewide emergency medical and trauma network impacts both directly and indirectly on 
the maintenance and supervision of the public highways of this state. 

(3) Therefore, it is the purpose of this part 6 to enhance emergency medical and trauma 
services statewide by financially assisting local emergency medical and trauma service 
providers who operate or wish to operate in the counties in their efforts to improve the 
quality and effectiveness of local emergency medical and trauma services, including 
emergency medical and trauma equipment and communications, and by supporting the 
overall coordination of such efforts by the department. 

Source: L. 89: Entire part added, p. 1148, § 2, effective July 1. L. 94: (3) amended, p. 
2758, § 421, effective July 1. L. 2000: Entire section amended, p. 532, § 10, effective July 
1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsecfion 
(3), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-3.5-602. Definitions. As used in this part 6, unless the context otherwise requires: 

(1) "Council" means the state emergency medical and trauma services advisory 
council created in section 25-3.5-104. 

(2) "Department" means the department of public health and environment. 

(3) "EMTS" means emergency medical and trauma services. 

(4) "Local emergency medical and trauma service providers" includes, but is not 
limited to, local governing boards, training centers, hospitals, special districts, and other 
private and public service providers that have as their purpose the provision of emergency 
medical and trauma services. 

Source: L. 89: Entire part added, p. 1149, § 2, effective July 1. L. 94: (2) amended, p. 
2758, § 422, effective July 1. L. 2000: (1), (3), and (4) amended, p. 532, § 11, effective 
July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-3.5-603. Emergency medical services account - creation - allocation of funds. 

(1) (a) There is hereby created a special account within the highway users tax fund 
established under section 43-4-201, C.R.S., to be known as the emergency medical services 
account, which consists of all moneys transferred thereto in accordance with section 
42-3-304 (21), C.R.S., and fees collected under section 25-3.5-203 for provisional certifi- 
cations of emergency medical service providers. 

(b) All moneys in and state FTE funded by the emergency medical services account 
shall be subject to annual appropriation by the general assembly. 

(c) At the end of any fiscal year, all unexpended and unencumbered moneys in the 
emergency medical services account shall remain therein and shall not be credited or 
transferred to the general fund or any other fund. Any interest earned on the investment or 
deposit of moneys in the account shall also remain in the account and shall not be credited 
to the general fund. 

(2) (Deleted by amendment, L. 2005, p. 280, § 13, effective August 8, 2005.) 

(3) On and after July 1, 2002, the general assembly shall appropriate moneys in the 
emergency medical services account: 

(a) (I) To the department for distribution as grants to local emergency medical and 
trauma service providers pursuant to the emergency medical and trauma services (EMTS) 
grant program set forth in section 25-3.5-604. 

(II) Of the amount appropriated under subparagraph (I) of this paragraph (a) for grants: 



Title 25 - page 177 Emergency Medical and Trauma Services 25-3.5-603 

(A) One hundred thousand dollars shall remain in the account for unexpected emer- 
gencies that arise after the deadline for grant applications has passed. The department and 
the council shall promulgate any rules necessary to define the expenditures of such 
emergency funds. 

(B) The department shall award a minimum of one hundred fifty thousand dollars to 
offset the training costs of emergency medical service providers, emergency medical 
dispatchers, emergency medical services instructors, emergency medical services coordi- 
nators, and other personnel who provide emergency medical services. Of said one hundred 
fifty thousand dollars, no less than eighty percent shall be used in the training of emergency 
medical service providers. 

(b) (I) To the department for distribution for each Colorado county within a RETAC no 
less than fifteen thousand dollars and seventy-five thousand dollars to each RETAC, in 
accordance with section 25-3.5-605 for planning and, to the extent possible, coordination of 
emergency medical and trauma services in the county and between counties when such 
coordination would provide for better service geographically. In the event that a RETAC is 
composed of less than five counties as of July 1 , 2002, the council shall recommend that for 
each Colorado county within such RETAC, the RETAC shall receive fifteen thousand 
dollars in accordance with section 25-3.5-605 for planning and, to the extent possible, 
coordination of emergency medical and trauma services in the county and between counties 
when such coordination would provide for better service geographically. Any RETAC may 
apply for additional moneys and may receive such moneys if the request is approved by the 
council, so long as the moneys are used in accordance with section 25-3.5-605 for planning 
and, to the extent possible, coordination of emergency medical and trauma services in the 
county and between counties when such coordination would provide for better service 
geographically. 

(II) A county may request to the council that the county's representative fifteen 
thousand dollars be divided between two different RETACs pursuant to section 25-3.5-704 
(2) (c) (IV) (B). 

(c) To the direct and indirect costs of planning, developing, implementing, maintaining, 
and improving the statewide emergency medical and trauma services system. These costs 
include: 

(1) Providing technical assistance and support to local governments, local emergency 
medical and trauma service providers, and RETACs operating a statewide data collection 
system, coordinating local and state programs, providing assistance in selection and 
purchasing of medical and communication equipment, administering the EMTS grant 
program, and establishing and maintaining scope of practice for certified medical service 
providers; and 

(II) The costs of the department of revenue in collecting the additional motor vehicle 
registration fee pursuant to section 42-3-304 (21), C.R.S. 

Source: L. 89: Entire part added, p. 1149, § 2, effective July 1. L. 92: Entire section 
amended, p. 1143, § 2, effective May 29. L. 94: (l)(a) and (2)(c)(III) amended, p. 2559, 
§ 61, effective January 1, 1995. L. 2000: IP(2), (2)(a)(I), (2)(a)(II)(A), (2)(b), IP(2)(c), 
(2)(c)(I), and (2)(c)(II) amended and (3) added, p. 533, § 12, effective July 1. L. 2005: 
(l)(a) and (3)(c)(II) amended, p. 1183, § 33, effective August 8; (l)(b) and (2) amended, p. 
280, § 13, effective August 8. L. 2009: (l)(a) amended, (HB 09-1275), ch. 278, p. 1245, 
§ 2, effective May 19. L. 2010: (3)(c)(I) amended, (HB 10-1260), ch. 403, p. 1947, § 11, 
effective July 1. L. 2012: (l)(a), IP(3), IP(3)(a)(II), (3)(a)(II)(B), IP(3)(c), and (3)(c)(I) 
amended, (HB 12-1059), ch. 271, p. 1437, § 21, effective July 1. 

Editor's note: (1) Subsection (3) was originally enacted as subsection (2.5) in Senate Bill 00-180 
but was renumbered on revision for ease of location. 

(2) Section 18 of chapter 271, Session Laws of Colorado 2012, provides that the act amending 
subsecdon (l)(a), the introductory portions to subsections (3) and (3)(a)(II), subsection (3)(a)(II)(B), 
the introductory portion to subsection (3)(c), and subsection (3)(c)(I) applies to acts committed on or 
after July 1, 2012. 



25-3.5-604 Health Title 25 - page 178 

25-3.5-604. EMTS grant program - EMS account - role of council and department 
- rules - awards. (1) (a) The council shall make recommendations to the department 
concerning the application for and distribution of moneys from the EMS account for the 
development, maintenance, and improvement of emergency medical and trauma services in 
Colorado and for the establishment of priorities for emergency medical and trauma services 
grants. 

(b) Any rules that relate to the distribution of grants shall provide that awards shall be 
made on the basis of a substantiated need and that priority shall be given to those applicants 
that have underdeveloped or aged emergency medical and trauma services equipment or 
systems. 

(c) The department, upon recommendations from the council, shall allocate moneys 
pursuant to section 25-3.5-603. 

(2) (a) Applications for grants shall be made to the department commencing January, 
2001, and each January thereafter, except as otherwise provided in section 25-3.5-603 (3). 

(b) The department shall review each application and make awards in accordance with 
the rules promulgated pursuant to subsection (1) of this section. 

(c) Grants awarded under this section shall require local matching funds, unless such 
requirement is waived by the council upon demonstration that local sources of matching 
funds are not available. 

(3) Grants shall be awarded July 1 of each year. 

(4) The council shall review the adequacy of funding for each RETAC for the period 
beginning July 1, 2002. The review shall be completed by December 31, 2005. The council 
may recommend any necessary changes to the department as a result of the review 
conducted pursuant to this subsection (4). 

Source: L. 89: Entire part added, p. 1150, § 2, effective July 1. L. 92: Entire section 
amended, p. 1145, § 3, effective May 29. L. 2000: (1), (2)(a), and (2)(b) amended and (4) 
added, p. 535, § 13, effective July 1. 

Editor's note: "EMS account" referenced in subsection (1) refers to the "emergency medical 
services account" created in § 25-3.5-603. 

25-3.5-605. Improvement of county emergency medical and trauma services - 
eligibility for county funding - manner of distributing funds. (1) Moneys in the 
emergency medical services account shall be apportioned pursuant to subsection (2.5) of 
this section. 

(2) In order to qualify for moneys under this section, a county must: 

(a) Comply with all provisions of part 3 of this article regarding the inspection and 
licensing of ambulances that are based in the county; 

(b) Require all licensed ambulance services to utilize the statewide emergency medical 
and trauma services uniform prehospital care reporting system operated by the department; 

(c) Repealed. 

(d) Ensure that all moneys received under this section are expended on developing and 
updating the emergency medical and trauma services plan and other emergency medical and 
trauma services needs of the county such as: 

(I) Training and certification of emergency medical service providers; 

(II) Assisting local emergency medical and trauma providers in applying for grants 
under section 25-3.5-604; 

(III) Improving the emergency medical and trauma services system on a county wide 
or regional basis and implementing the county emergency medical and trauma services 
plan; 

(e) Repealed. 

(2.5) (a) On or before October 1 , 2003, and on or before October 1 each year thereafter, 
each RETAC shall submit to the council an annual financial report that details the 
expenditure of moneys received. Such report shall be in a format specified by the council 
and the department. In instances where the council finds such report inadequate, the RETAC 
shall resubmit the report to the council by December 1 of the same year. 



Title 25 - page 179 Emergency Medical and Trauma Services 25-3.5-607 

(b) On or before July 1, 2003, and on or before July 1 each odd-numbered year 
thereafter, each RETAC shall submit to the council a biennial plan that details the RETAC's 
EMTS plan and any revisions pursuant to section 25-3.5-704 (2) (c) (I) (B). If the RETAC 
includes a county that has been divided geographically pursuant to section 25-3.5-704 (2) 
(c) (IV), the plan shall include an evaluation of such division. Such plan shall be in a format 
specified by the council and the department. In instances where the council finds such plan 
inadequate, the RETAC shall resubmit the plan to the council by September 14 of the same 
year. 

(c) On or before October 15, 2003, and on or before October 15 each odd-numbered 
year thereafter, the council shall submit to the department a plan for all RETACs in the state. 
On or before November 1, 2003, and on or before November 1 each odd-numbered year 
thereafter, the department, in consultation with the council, shall approve a plan for all 
RETACs in the state. 

(3) Funds distributed to counties and RETACs pursuant to this section shall be used in 
planning the improvement of existing county emergency medical and trauma service 
programs and shall not be used to supplant moneys already allocated by the county for 
emergency medical and trauma services. 

(4) (a) Failure to comply with the requirements of subsection (2) of this section shall 
render a county ineligible to receive moneys from the emergency medical services account 
until the following January. 

(b) At the end of any fiscal year, moneys which are not distributed to a county shall 
remain in the emergency medical services account until the following January. 

Source: L. 89: Entire part added, p. 1151, § 2, effective July 1. L. 92: Entire section 
amended, p. 1145, § 4, effective May 29. L. 2002: (1), (2), and (3) amended and (2.5) 
added, p. 697, § 3, effective May 29. L. 2005: (1) amended, p. 281, § 14, effective August 
8. L. 2012: IP(2), IP(2)(d), and (2)(d)(l) amended, (HB 12-1059), ch. 271, p. 1438, § 22, 
effective July 1. 

Editor's note: (1) Subsection (2)(c)(II) provided for the repeal of subsection (2)(c) and subsec- 
tion (2)(e)(II) provided for the repeal of subsecfion (2)(e), effective October 1, 2002. (See L. 2002, 
p. 697.) 

(2) Section 1 8 of chapter 27 1 , Session Laws of Colorado 20 1 2, provides that the act amending the 
introductory portions to subsections (2) and (2)(d) and subsection (2)(d)(I) applies to acts committed 
on or after July 1, 2012. 

25-3.5-606. Annual report. No later than January 1 , 1 99 1 , and prior to November 1 of 
each year thereafter, the department, in cooperation with the council, shall submit a report 
to the health, environment, welfare, and institutions committees and the joint budget 
committee of the general assembly on the moneys credited to the emergency medical 
services account and on the expenditure of such moneys during the preceding fiscal year. 
Such report shall contain a listing of the grant recipients, proposed projects, and a statement 
of the short-term and long-term planning goals of the department and the council to further 
implement the provisions of this part 6. 

Source: L. 89: Entire part added, p. 1152, § 2, effective July 1. L. 92: Entire section 
amended, p. § 1147, § 5, effective May 29. L. 2000: Entire section amended, p. 537, § 15, 
effective July 1; entire section amended, p. 461, § 3, effective August 2. 

Editor's note: Amendments to this section by Senate Bill 00-180 and House Bill 00-1297 were 
harmonized. 

25-3.5-607. Repeal of part. (Repealed) 

Source: L. 89: Entire part added, p. 1152, § 2, effective July 1. L. 92: Entire section 
amended, p. 1147, § 6, effective May 29. L. 96: Entire section repealed, p. 170, § 1, 
effective April 8. 



25-3.5-701 Health Title 25 - page 1 80 

PART 7 
STATEWIDE TRAUMA SYSTEM 

Editor's note: This part 7 was repealed and reenacted in 1994 and was subsequently repealed and 
reenacted in 1995, resulting in the addition, relocation, and elimination of sections as well as subject 
matter. For amendments to this part 7 prior to 1995, consult the Colorado statutory research 
explanatory note and the table itemizing the replacement volumes and supplements to the original 
volume of C.R.S. 1973 beginning on page vii in the front of this volume. 

25-3.5-701. Short title. This part 7 shall be known and may be cited as the "Statewide 
Trauma Care System Act". 

Source: L. 95: Entire part R&RE, p. 1351, § 3, effective July 1. 

25-3.5-702. Legislative declaration. (1) The general assembly hereby finds and 
declares that trauma is the greatest single cause of death and disability in Colorado for 
persons under the age of forty-five years and that trauma care is a unique type of emergency 
medical service. 

(2) The general assembly further finds that a trauma system task force made up of 
various emergency health and trauma care entities submitted a report to the general 
assembly in 1993 indicating a compelling need to develop and implement a statewide 
trauma care system in order to assure that appropriate resources are available to trauma 
victims from the point of injury through rehabilitative care. In addition, a statewide system 
is essential to provide Colorado residents and visitors with a greater probability of surviving 
a life-threatening injury and to reduce trauma-related morbidity and mortality in this state. 

(3) The general assembly, therefore, declares that it is necessary to enact legislation 
directing the board of health to adopt rules that govern the implementation and oversight of 
the trauma care system. The general assembly further declares that to ensure the availability 
and coordination of resources necessary to provide essential care, it is necessary to enact 
legislation that directs the department of public health and environment to collaborate with 
existing agencies and organizations, including governing bodies for counties and cities and 
counties, in implementing and monitoring a statewide trauma care system. 

Source: L. 95: Entire part R&RE, p. 1351, § 3, effective July 1. 

25-3.5-703. Definitions. As used in this article, unless the context otherwise requires: 

(1) (Deleted by amendment, L. 2000, p. 537, § 16, effective July 1, 2000.) 

(2) "Board" means the state board of health. 

(3) Repealed. 

(3.5) "Council" means the state emergency medical and trauma services advisory 
council created by section 25-3.5-104. 

(4) "Designation" means the process undertaken by the department to assign a status 
to a health care facility based on the level of trauma services the facility is capable of and 
committed to providing to injured persons. Facilities may be designated at one of the 
following levels: 

(a) Nondesignated, which is for facilities that do not meet the criteria required for level 
I to V facilities, but that receive and are accountable for injured persons, which account- 
ability includes having a transfer agreement to transfer persons to level I to V facilities as 
determined by rules promulgated by the board; 

(a.5) Level V, which is for basic trauma care in rural areas, including resuscitation, 
stabilization, and arrangement for the transfer of all patients with potentially life- or 
limb-threatening injuries, consistent with triage and transport protocols as recommended by 
the council and adopted by the board. Level V facilities shall transfer patients within their 
own region or to a higher level facility in another region, as described in paragraphs (c), (d), 
and (e) of this subsection (4). 



Title 25 - page 181 Emergency Medical and Trauma Services 25-3.5-703 

(b) Level IV, which is for basic trauma care, including resuscitation, stabilization, and 
arrangement for appropriate transfer of persons requiring a higher level of care based upon 
patient criticality and triage practices within each facility, which are consistent with triage 
criteria and transport protocols as recommended by the council and adopted by the board. 
These facilities must transfer appropriate patients to a higher level facility within their own 
region or to a higher level facility in another region, as described in paragraphs (d) and (e) 
of this subsection (4). 

(c) Level III, which is for general trauma care, including resuscitation, stabilization, 
and assessment of injured persons, and either the provision of care for the injured person 
or arrangement for appropriate transfer based upon patient criticality and triage practices 
within each facility, which are consistent with triage criteria and transport protocols as 
recommended by the council and adopted by the board. The facilities must transfer 
appropriate patients to a higher level facility within its own region or to a higher level 
facility in another region, as described in paragraphs (d) and (e) of this subsection (4). 

(d) Level II, which is for major trauma care based upon patient criticality and triage 
practices within each facility, which are consistent with triage criteria and transport 
protocols as recommended by the council and adopted by the board. This type of facility 
may serve as a resource for lower level facilities when a level I facility, as described in 
paragraph (e) of this subsection (4), is not available within its region, but it is not a facility 
required to conduct research or provide comprehensive services through subspecialty units 
such as, but not limited to, bum units, spinal cord injury centers, eye trauma centers, and 
reimplantation centers. 

(e) Level I, which is for comprehensive trauma care, including the acute management 
of the most severely injured patients, which is a facility that may serve as the ultimate 
resource for lower level facilities or as the key resource facility for a trauma area and which 
is a facility that provides education in trauma-related areas for health care professionals and 
performs trauma research; 

(f) Regional pediatric trauma center, which is a facility that provides comprehensive 
pediatric trauma care, including acute management of the most severely injured pediatric 
trauma patients, and is a facility that may serve as an ultimate resource for lower level 
facilities on pediatric trauma care, and which is a facility that performs pediatric trauma 
research and provides pediatric trauma education for health care professionals. No facility 
shall be deemed a regional pediatric trauma center unless the facility predominately serves 
children and is a facility where at least eighty-five percent of hospital admissions are for 
individuals who are under eighteen years of age. A separate administrative unit within a 
general hospital or hospital system shall not be deemed a regional pediatric trauma center. 

(5) (Deleted by amendment, L. 2000, p. 537, § 16, effective July 1, 2000.) 

(6) "Interfacility transfer" means the movement of a trauma victim from one facility to 
another. 

(6.5) "Key resource facility" means a level I or level II certified trauma facility that 
provides consultation and technical assistance to a RETAC, as such term is defined in 
subsection (6.8) of this section, regarding education, quality, training, communication, and 
other trauma issues described in this part 7 that relate to the development of the statewide 
trauma care system. 

(6.8) "Regional emergency medical and trauma services advisory council" or 
"RETAC" means the representative body appointed by the governing bodies of counties or 
cities and counties for the purpose of providing recommendations concerning regional area 
emergency medical and trauma service plans for such counties or cities and counties. 

(7) Repealed. 

(8) "Statewide trauma registry" means a statewide data base of information concerning 
injured persons and licensed facilities receiving injured persons, which information is used 
to evaluate and improve the quality of patient management and care and the quality of 
trauma education, research, and injury prevention programs. The data base integrates 
medical and trauma systems information related to patient diagnosis and provision of care. 
Such information includes epidemiologic and demographic information. 

(9) "Trauma" means an injury or wound to a living person caused by the application 
of an external force or by violence. Trauma includes any serious life-threatening or 
limb-threatening situations. 



25-3.5-704 Health Title 25 - page 182 

(10) "Trauma care system" means an organized approach to providing quality and 
coordinated care to trauma victims throughout the state on a twenty-four-hour per day basis 
by transporting a trauma victim to the appropriate trauma designated facility. 

(11) "Trauma transport protocols" means written standards adopted by the board that 
address the use of appropriate resources to move trauma victims from one level of care to 
another on a continuum of care. 

(12) "Triage" means the assessment and classification of an injured person in order to 
determine the severity of trauma injury and to prioritize care for the injured person. 

(13) "Verification process" means a procedure to evaluate a facility's compliance with 
trauma care standards established by the board and to make recommendations to the 
department concerning the designation of a facility. 

Source: L. 95: Entire part R&RE, p. 1352, § 3, effective July 1. L. 99: (4) amended, 
p. 412, § 1, effective April 22. L. 2000: (1), (4)(a), (4)(b), (4)(c), (4)(d), (4)(f), (5), and 
(6.5) amended and (3.5), (4)(a.5), and (6.8) added, pp. 537, 538, §§ 16, 17, effective July 
1; (3) and (7) repealed, p. 547, § 26, effective January 1, 2001. 

25-3.5-704. Statewide emergency medical and trauma care system - development 
and implementation - duties of department - rules adopted by board. (1) The 

department shall develop, implement, and monitor a statewide emergency medical and 
trauma care system in accordance with the provisions of this part 7 and with rules adopted 
by the state board. The system shall be implemented statewide no later than July 1, 1997. 
In addition, the board shall cooperate with the department of personnel in adopting criteria 
for adequate communications systems that counties shall be required to identify in regional 
emergency medical and trauma system plans in accordance with subsection (2) of this 
section. Pursuant to section 24-50-504 (2), C.R.S., the department may contract with any 
public or private entity in performing any of its duties concerning education, the statewide 
trauma registry, and the verification process as set forth in this part 7. 

(2) The board shall adopt rules for the statewide emergency medical and trauma care 
system, including but not limited to the following: 

(a) Minimum services in rendering patient care. These rules ensure the appropriate 
access through designated centers to the following minimum services: 

(I) Prehospital care; 

(II) Hospital care; 

(III) Rehabilitative care; 

(IV) Injury prevention; 

(V) Disaster medical care; 

(VI) Education and research; and 

(VII) Trauma communications. 

(b) Transport protocols. The board shall set forth trauma transport protocols in these 
rules, which include but are not limited to a requirement that a facility that receives an 
injured person provide the appropriate available care, which may include stabilizing an 
injured person before transferring that person to the appropriate facility based on the 
person's injury. These rules ensure that when the most appropriate trauma facility for an 
injured person is not easily accessible in an area, that person will be transferred as soon as 
medically feasible to the nearest appropriate facility, which may be in or out of the state. 
These rules shall conform with applicable federal law governing the transfer of patients. 

(c) Regional emergency medical and trauma advisory councils - plans established 
- process. (I) These rules provide for the implementation of regional emergency medical 
and trauma system plans that describe methods for providing the appropriate service and 
care to persons who are ill or injured in areas included under a regional emergency medical 
and trauma system plan. In these rules, the board shall specify that: 

(A) The governing body of each county or city and county throughout the state shall 
establish a regional emergency medical and trauma advisory council (RETAC) with the 
governing body of four or more other counties, or with the governing body of a city and 
county, to form a multicounty RETAC. The number of members on a RETAC shall be 
defined by the participating counties. Membership shall reflect, as equally as possible, 



Title 25 - page 183 Emergency Medical and Trauma Services 25-3.5-704 

representation between hospital and prehospital providers and from each participating 
county and city and county. There shall be at least one member from each participating 
county and city and county in the RETAC. Each county within a RETAC shall be located 
in reasonable geographic proximity to the other counties and city and counties within the 
same RETAC. In establishing a RETAC, the governing body shall obtain input from health 
care facilities and providers within the area to be served by the RETAC. If the governing 
body for a county or city and county fails to establish a RETAC by July 1, 2002, two 
counties with a combined population of at least seven hundred fifty thousand residents may 
apply to the council for establishment of a RETAC of fewer than four counties. The council 
shall conduct a hearing with all counties that may be affected by the establishment of a 
RETAC with fewer than four counties before deciding whether to grant such application. 
The decision on such an application shall be completed within sixty days after the date of 
application. For all other counties that do not qualify as a two-county RETAC and that have 
not established a RETAC by July 1, 2002, the council shall designate an established RETAC 
to serve as the county's or city and county's RETAC. 

(B) No later than July 1, 2003, each RETAC with approval from the governing bodies 
for a multicounty RETAC shall submit a regional emergency medical and trauma system 
plan to the council for approval by the department. If the governing body for a county or 
city and county fails to submit a plan, if a county or city and county is not included in a 
multicounty plan, or, if a multicounty plan is not approved pursuant to a procedure 
established by the board for approving plans, the department shall design a plan for the 
county, city and county, or multicounty area. 

(II) In addition to any issues the board requires to be addressed, every regional 
emergency medical and trauma system plan shall address the following issues: 

(A) The provision of minimum services and care at the most appropriate facihties in 
response to the following factors: Facility-established triage and transport plans; 
interfacihty transfer agreements; geographical barriers; population density; emergency 
medical services and trauma care resources; and accessibility to designated facilities; 

(B) The level of commitment of counties and city and counties under a regional 
emergency medical and trauma system plan to cooperate in the development and imple- 
mentation of a statewide communications system and the statewide emergency medical and 
trauma care system; 

(C) The methods for ensuring facility and county or city and county adherence to the 
regional emergency medical and trauma system plan, compliance with board rules and 
procedures, and commitment to the continuing quality improvement system described in 
paragraph (h) of this subsection (2); 

(D) A description of public information, education, and prevention programs to be 
provided for the area; 

(E) A description of the functions that will be contracted services; and 

(F) The identification of regional emergency medical and trauma system needs through 
the use of a needs assessment instrument developed by the department; except that the use 
of such instrument shall be subject to approval by the counties and city and counties 
included in a RETAC. 

(III) The board shall specify in regional emergency medical and trauma system plan 
rules the time frames for approving regional emergency medical and trauma system plans 
and for resubmitting plans, as well as the number of times the plans may be resubmitted by 
a governing body before the department designs a plan for a multicounty area. The 
department shall provide technical assistance to any RETAC for preparation, implementa- 
tion, and modification, as necessary, of regional emergency medical and trauma system 
plans. 

(IV) (A) A county may request that the county be included in two separate RETACs 
because of geographical concerns. The council shall review and approve any request that a 
county be divided prior to inclusion within two separate RETACs if the county demon- 
strates such a division will not adversely impact the emergency medical and trauma needs 
for the county, that such a division is beneficial to both RETACs, and that such division does 
not create a RETAC with fewer than five contiguous counties, except for RETACs that 



25-3.5-704 Health Title 25 - page 184 

contain two counties with a combined population of at least seven hundred fifty thousand 
residents pursuant to sub-subparagraph (A) of subparagraph (I) of this paragraph (c). 

(B) A county that is included in two separate RETACs may request that the council 
allocate any portion of the fifteen thousand dollars received by a RETAC, pursuant to 
section 25-3.5-603, between the two separate RETACs. 

(d) Designation of facilities. The designation rules shall provide that every facility in 
this state required to be licensed in accordance with article 3 of this title and that receives 
ambulance patients shall participate in the statewide emergency medical and trauma care 
system. Each such facility shall submit an application to the department requesting 
designation as a specific level trauma facility or requesting nondesignation status. A facility 
that is given nondesignated status shall not represent that it is a designated facility, as 
prohibited in section 25-3.5-707. The board shall include provisions for the following: 

(I) The criteria to be applied for designating and periodically reviewing facilities based 
on level of care capability providing trauma care. In establishing such criteria, the board 
shall take into consideration recognized national standards including, but not limited to, 
standards on trauma resources for optimal care of the injured patient adopted by the 
American college of surgeons' committee and the guidelines for trauma care systems 
adopted by the American college of emergency physicians. 

(II) A verification process; 

(III) The length of a designation period; 

(IV) The process for evaluating, reviewing, and designating facilities, including an 
ongoing periodic review process for designated facilities, which process shall take into 
account the national standards referenced in subparagraph (I) of this paragraph (d). Each 
facility shall be subject to review in accordance with rules adopted pursuant to this 
paragraph (d). In the event a certified facility seeks to be designated at a different level or 
seeks nondesignation status, the facility shall comply with the board's procedures for initial 
designation. 

(V) Disciplinary sanctions, which shall be limited to the revocation of a designation, 
temporary suspension while the facility takes remedial steps to correct the cause of the 
discipline, redesignation, or assignment of nondesignation status to a facility; 

(VI) A designation fee established in accordance with section 25-3.5-705; and 

(VII) An appeals process concerning department decisions in connection with evalua- 
tions, reviews, designations, and sanctions. 

(e) Communications system. (I) The communications system rules shall require that 
a regional emergency medical and trauma system plan ensure citizen access to emergency 
medical and trauma services through the 911 telephone system or its local equivalent and 
that the plan include adequate provisions for: 

(A) Public safety dispatch to ambulance service and for efficient communication from 
ambulance to ambulance and from ambulance to a designated facility; 

(B) Efficient communications among the trauma facilities and between trauma facilities 
and other medical care facilities; 

(C) Efficient communications among service agencies to coordinate prehospital, day- 
to-day, and disaster activities; and 

(D) Efficient communications among counties and RETACs to coordinate prehospital, 
day-to-day, and disaster activities. 

(II) In addition, the board shall require that a regional emergency medical and trauma 
system plan identify the key resource facilities for the area. The key resource facilities shall 
assist the RETAC in resolving trauma care issues that arise in the area and in coordinating 
patient destination and interfacility transfer policies to assure that patients are transferred to 
the appropriate facility for treatment in or outside of the area. 

(f) Statewide trauma registry. (I) The registry rules shall require the department to 
establish and oversee the operation of a statewide trauma registry. The rules shall allow for 
the provision of technical assistance and training to designated facilities within the various 
trauma areas in connection with requirements to collect, compile, and maintain information 
for the statewide central registry. Each licensed facility, clinic, or prehospital provider that 
provides any service or care to or for persons with trauma injury in this state shall collect 
the information described in this subparagraph (I) about any such person who is admitted 



Title 25 - page 185 Emergency Medical and Trauma Services 25-3.5-704 

to a hospital as an inpatient or transferred from one facility to another or who dies from 
trauma injury. The facility, clinic, or prehospital provider shall submit the following 
information to the registry: 

(A) Admission and readmission information; 

(B) Number of trauma deaths; 

(C) Number and types of transfers to and from the facility or the provider; and 

(D) Injury cause, type, and severity. 

(II) In addition to the information described in subparagraph (I) of this paragraph (f), 
facilities designated as level I, II, or III shall provide such additional information as may be 
required by board rules. 

(III) The registry rules shall include provisions concerning access to information in the 
registry that does not identify patients or physicians. Any data maintained in the registry that 
identifies patients or physicians shall be strictly confidential and shall not be admissible in 
any civil or criminal proceeding. 

(g) Public information, education, and injury prevention. The department and 
county, district, and municipal public health agencies may operate injury prevention 
programs, but the public information, education, and injury prevention rules shall require 
the department and county, district, and municipal public health agencies to consult with the 
state and regional emergency medical and trauma advisory councils in developing and 
implementing area and state-based injury prevention and public information and education 
programs including, but not limited to, a pediatric injury prevention and public awareness 
component. In addition, the rules shall require that regional emergency medical and trauma 
system plans include a description of public information and education programs to be 
provided for the area. 

(h) (I) Continuing quality improvement system (CQI). These rules require the 
department to oversee a continuing quality improvement system for the statewide emer- 
gency medical and trauma care system. The board shall specify the methods and periods for 
assessing the quality of regional emergency medical and trauma systems and the statewide 
emergency medical and trauma care system. These rules include, but are not limited to, the 
following requirements: 

(A) That RETACs assess periodically the quality of their respective regional emergency 
medical and trauma system plans and that the state assess periodically the quality of the 
statewide emergency medical and trauma care system to determine whether positive results 
under regional emergency medical and trauma system plans and the statewide emergency 
medical and trauma care system can be demonstrated; 

(B) That all facilities comply with the trauma registry rules; 

(C) That reports concerning regional emergency medical and trauma system plans 
include results for the emergency medical and trauma area, identification of problems under 
the regional emergency medical and trauma system plan, and recommendations for resolv- 
ing problems under the plan. In preparing these reports, the RETACs shall obtain input from 
facilities, counties included under the regional emergency medical and trauma system plan, 
and service agencies. 

(D) That the names of patients or information that identifies individual patients shall be 
kept confidential and shall not be publicly disclosed without the patient's consent; 

(E) That the department be allowed access to prehospital, hospital, and coroner records 
of emergency medical and trauma patients to assess the continuing quality improvement 
system for the area and state-based injury prevention and public information and education 
programs pursuant to paragraph (g) of this subsection (2). All information provided to the 
department shall be confidential pursuant to subparagraph (II) of this paragraph (h). To the 
greatest extent possible, patient-identifying information shall not be gathered. If patient- 
identifying information is necessary, the department shall keep such information strictly 
confidential, and such information may only be released outside of the department upon 
written authorization of the patient. The department shall prepare an annual report that 
includes an evaluation of the statewide emergency medical and trauma services system. 
Such report shall be distributed to all designated trauma centers, ambulance services, and 
service agencies and to the chairpersons of the health and human services committees of the 
house of representatives and the senate, or any successor committees. 



25-3.5-705 Health Title 25 - page 1 86 

(II) Any data or information related to the identification of individual patient's, 
provider's, or facility's care outcomes collected as a result of the continuing quality 
improvement system and any records or reports collected or compiled as a result of the 
continuing quality improvement system are confidential and are exempt from the open 
records law in part 2 of article 72 of title 24, C.R.S. Such data, information, records, or 
reports shall not be subject to subpoena or discovery and shall not be admissible in any civil 
action, except pursuant to a court order that provides for the protection of sensitive 
information about interested parties. Nothing in this subparagraph (II) shall preclude the 
patient or the patient's representative from obtaining the patient's medical records as 
provided in section 25-1-801. Nothing in this subparagraph (II) shall be construed to allow 
access to confidential professional review committee records or reviews conducted under 
article 36.5 of title 12, C.R.S. 

(III) That reports concerning regional emergency medical and trauma system plans 
include results for the emergency medical and trauma area, identification of problems under 
the regional emergency medical and trauma system plan, and recommendations for resolv- 
ing problems under the plan. In preparing these reports, the RETACs shall obtain input from 
facilities, counties included under the regional emergency medical and trauma system plan, 
and service agencies. 

(i) Trauma care for pediatric patients. The trauma care for pediatric patient rules 
shall provide for the improvement of the quality of care for pediatric patients. 

(3) The board shall adopt rules that take into consideration recognized national stan- 
dards for emergency medical and trauma care systems, such as the standards on trauma 
resources for optimal care of the injured patient adopted by the American college of 
surgeons' committee on trauma and the guidelines for emergency medical and trauma care 
systems adopted by the American college of emergency physicians and the American 
academy of pediatrics. 

(4) The board shall adopt and the department shall use only cost-efficient administrative 
procedures and forms for the statewide emergency medical and trauma care system. 

(5) In adopting its rules, the board shall consult with and seek advice from the council, 
as defined in section 25-3.5-703 (3.5), where appropriate, and from any other appropriate 
agency. In addition, the board shall obtain input from appropriate health care agencies, 
institutions, facilities, and providers at the national, state, and local levels and from counties 
and city and counties. 

Source: L. 95: Entire part R&RE, p. 1354, § 3, effective July 1. L. 96: (1) amended, 
p. 1471, § 19, effective June 1. L. 99: IP(2) and (2)(h) amended, p. 413, § 2, effective 
April 22. L. 2002: (1), IP(2), (2)(c), IP(2)(d), (2)(d)(IV), (2)(d)(V), (2)(e), (2)(f)(III), 
(2)(g), IP(2)(h)(I), (2)(h)(I)(A), (2)(h)(I)(C), (2)(h)(III), (3), (4), and (5) amended and 
(2)(h)(I)(E) added, p. 699, § 4, effective May 29. L. 2003: (2)(d)(I) and (2)(d)(IV) 
amended, p. 2057, § 1, effective May 22; (2)(h)(I)(E) amended, p. 2007, § 85, effective 
May 22. L. 2004: (1) amended, p. 1693, § 27, effective July 1, 2005. L. 2005: IP(2)(d) 
amended, p. 281, § 15, effective August 8. L. 2007: (2)(h)(I)(E) amended, p. 2041, § 66, 
effective June 1. L. 2010: (2)(g) amended, (HB 10-1422), ch. 419, p. 2092, § 88, effective 
August 11. 

25-3.5-705. Creation of fee - creation of trauma system cash fund. ( 1 ) The board 
is authorized, by rule, to establish a schedule of fees based on the direct and indirect costs 
incurred in designating facilities. In addition, the department is authorized to collect the 
appropriate fee on the schedule. The board may adjust fees in amounts necessary to cover 
such costs. The fees collected pursuant to this section shall be deposited in the trauma 
system cash fund created by subsection (2) of this section. 

(2) There is hereby created in the state treasury a statewide trauma care system cash 
fund. All moneys in the fund shall be subject to appropriation by the general assembly for 
allocation to the department to administer the trauma system. Any moneys in the fund not 
appropriated shall remain in the fund and shall not be transferred or revert to the general 
fund at the end of any fiscal year. All interest derived from the deposit and investment of 
moneys in the fund shall remain in the fund. 



Title 25 - page 187 Emergency Medical and Trauma Services 25-3.5-709 

Source: L. 95: Entire part R&RE, p. 1359, § 3, effective July 1. 

25-3.5-706. Immunity from liability. The department, the board, the council as 
defined in section 25-3.5-703 (3.5), a RETAC as defined in section 25-3.5-703 (6.8), the 
emergency medical practice advisory council created in section 25-3.5-206, key resource 
facilities, any other public or private entity acting on behalf of or under contract with the 
department, and counties and cities and counties shall be immune from civil and criminal 
liability and from regulatory sanction for acting in compliance with the provisions of this 
part 7, Nothing in this section shall be construed as providing any immunity to such entities 
or any other person in connection with the provision of medical treatment, care, or services 
that are governed by the medical malpractice statutes, article 64 of title 13, C.R.S. 

Source: L. 95: Entire part R&RE, p. 1360, § 3, effective July 1. L. 2000: Entire section 
amended, p. 545, § 19, effective July 1. L. 2010: Entire section amended, (HB 10-1260), 
ch. 403, p. 1948, § 12, effective July 1. 

25-3.5-707. False representation as trauma facility - penalty. (1) No facility, or 
agent or employee of a facility, shall represent that the facility functions as a level I, II, III, 
IV, or V trauma facility unless the facility possesses a valid certificate of designation issued 
pursuant to section 25-3.5-704 (2) (d). In addition, no facility, provider, or person shall 
violate any rule adopted by the board. 

(2) Any facility, provider, or person who violates the provisions of subsection ( 1 ) of this 
section is subject to a civil penalty, which the board shall establish by rule, but which shall 
not exceed five hundred dollars. The penalty shall be assessed and collected by the 
department. Before a fee is collected, a facility, provider, or person shall be provided an 
opportunity for review of the assessed penalty. The procedures for review shall be in 
accordance with the "State Administrative Procedure Act", article 4 of title 24, C.R.S., and 
board rules. Any penalty collected pursuant to this section shall be transmitted to the state 
treasurer, who shall credit the same to the statewide trauma care system cash fund created 
in section 25-3.5-705. 

Source: L. 95: Entire part R&RE, p. 1360, § 3, effective July 1. L. 2000: (1) amended, 
p. 545, § 20, effective July 1. 

25-3.5-708. Financing for statewide trauma system. (1) The implementation of the 
statewide trauma system shall be subject to the availability of: 

(a) Federal transportation highway safety seed moneys that the department of trans- 
portation transfers to the department of public health and environment pursuant to an 
intergovernmental agreement between the two agencies; 

(b) Moneys from the emergency medical services account within the highway users tax 
fund that are unexpended portions of state administrative funds that may be allocated 
pursuant to section 25-3.5-603 (2) (c). Nothing in this paragraph (b) shall be construed to 
authorize moneys that may be allocated pursuant to section 25-3.5-603 (2) (a) (I) or (2) (b) 
to be used for the financing of the administration of the statewide trauma system. 

(c) Moneys from the statewide trauma care system cash fund created in section 
25-3.5-705. 

(2) In addition to any funds available pursuant to subsection (1) of this section, the 
executive director of the department of public health and environment is hereby authorized 
to accept any grants, donations, gifts, or contributions from any other private or public 
entity for the purpose of implementing this part 7. 

Source: L. 95: Entire part R&RE, p. 1360, § 3, effective July 1. 

25-3.5-709. Annual report. No later than January 1, 1999, and prior to November 1 of 
each year thereafter, the department, in cooperation with the council, as defined in section 
25-3.5-703 (3.5), shall submit a report to the health, environment, welfare, and institutions 



25-3.5-801 Health Title 25 - page 188 

committees and the joint budget committee of the general assembly on the quality of the 
statewide emergency medical and trauma care system. Such report shall include an 
evaluation of each component of the statewide emergency medical and trauma care system 
and any recommendation for legislation concerning the statewide emergency medical and 
trauma care system or any component thereof. 

Source: L. 95: Entire part R&RE, p. 1361, § 3, effective July 1. L. 2000: Entire section 
amended, p. 545, § 21, effective July 1; entire section amended, p. 462, § 4, effective 
August 2. 

Editor's note: Amendments to this section by Senate Bill 00-180 and House Bill 00-1297 were 
harmonized. 

PART 8 

TOBACCO EDUCATION, PREVENTION, 
AND CESSATION PROGRAMS 

25-3.5-801. Short title. This part 8 shall be known and may be cited as the "Tobacco 
Education, Prevention, and Cessation Act". 

Source: L. 2000: Entire part added, p. 613, § 13, effective May 18. 

25-3.5-802. Legislative declaration. (1) The general assembly hereby finds that: 

(a) The use of all types of tobacco products, including smokeless tobacco, results in a 
high incidence of addiction, disease, illness, and death; 

(b) Persons who begin using and become addicted to tobacco products in their youth 
often face a lifetime of struggle and recurring illness in coping with and attempting to 
overcome addiction to tobacco products; 

(c) Experimentation with tobacco products by youth is often a first step toward more 
serious drug experimentation and creates a greater likelihood that the youth who experiment 
with tobacco will at some point be addicted to even more harmful substances; 

(d) Implementation of aggressive tobacco and substance abuse prevention, education, 
and cessation programs for school-age children is necessary to assist young people in 
avoiding and ending tobacco use; 

(e) School districts, schools, and other entities that provide tobacco and substance 
abuse prevention, education, and cessation programs for school-age children should reach 
out to parents and encourage them to participate, either as students or role models, in 
implementing said programs. 

(2) The general assembly hereby finds that persons with mental illness are more likely 
to abuse tobacco products than any other segment of society. The general assembly further 
finds that the unusually heavy pattern of tobacco abuse engaged in by persons with mental 
illness requires special treatment strategies that are not provided by other alcohol, drug, or 
tobacco abuse programs. It is therefore the general assembly's intent that the programs 
funded pursuant to this part 8 include comprehensive programs to prevent and treat tobacco 
addiction among persons with mental illness. 

(3) The general assembly also finds that: 

(a) Each year, thousands of people in this state die from diseases that have been 
clinically proven to be caused by or directly related to tobacco use; 

(b) Once a person starts using tobacco, he or she usually becomes addicted to the 
nicotine contained in the tobacco, which makes it terribly difficult for the person to quit 
using tobacco even when the person is aware of the significant health risks that accompany 
tobacco use; 

(c) Studies show that a child is at a substantially greater risk of starting to use tobacco 
if the child's parents or older siblings use tobacco. Therefore, reducing tobacco use by 
adults may significantly reduce the risk that children will begin using tobacco. 



Title 25 - page 189 Emergency Medical and Trauma Services 25-3.5-804 

(d) Annual direct medical costs from tobacco use in Colorado currently exceed one 
billion dollars; 

(e) Comprehensive tobacco education, prevention, and cessation programs may result 
in millions of dollars in savings to the state and individual residents of the state for 
generations. 

Source: L. 2000: Entire part added, p. 613, § 13, effective May 18. L. 2005: (3)(d) 
amended, p. 932, § 22, effective June 2. 

Cross references: For the legislative declaration contained in the 2005 act amending subsection 
(3)(d), see section 1 of chapter 241, Session Laws of Colorado 2005. 

25-3.5-803. Definitions. As used in this part 8, unless the context otherwise requires: 

(1) "Division" means the division within the department of pubhc health and envi- 
ronment responsible for prevention services. 

(2) "Entity" means any local government, county, district, or municipal public health 
agency, political subdivision of the state, county department of social services, state agency, 
state institution of higher education that offers a teacher education program, school, school 
district, or board of cooperative services or any private nonprofit or not-for-profit commu- 
nity-based organization. "Entity" also means a for-profit organization that applies for a 
grant for the sole purpose of providing a statewide public information campaign concerning 
tobacco use prevention and cessation. 

(3) "Master settlement agreement" means the master settlement agreement, the smoke- 
less tobacco master settlement agreement, and the consent decree approved and entered by 
the court in the case denominated State of Colorado, ex rel. Gale A. Norton, Attorney 
General v. RJ. Reynolds Tobacco Co.; American Tobacco Co., Inc.; Brown & Williamson 
Tobacco Corp.; Liggett & Myers, Inc.; Lorillard Tobacco Co., Inc.; Philip Morris, Inc.; 
United States Tobacco Co.; B.A.T Industries, RL.C; The Council For Tobacco Research — 
U.S.A., Inc.; and Tobacco Institute, Inc., Case No. 97 CV 3432, in the district court for the 
city and county of Denver. 

(4) "Program" means the tobacco education, prevention, and cessation grant program 
created in section 25-3.5-804. 

(5) "State board" means the state board of health created in section 25-1-103. 

Source: L. 2000: Entire part added, p. 614, § 13, effective May 18. L. 2005: (2) 
amended, p. 932, § 23, effective June 2. L. 2009: (1) amended, (SB 09-292), ch. 369, p. 
1970, § 85, effective August 5. L. 2010: (2) amended, (HB 10-1422), ch. 419, p. 2092, 
§ 89, effective August 1 1 . 

Cross references: For the legislative declaration contained in the 2005 act amending subsection 
(2), see section 1 of chapter 241, Session Laws of Colorado 2005. 

25-3.5-804. Tobacco education, prevention, and cessation programs - review com- 
mittee - grants. (1) There is hereby created the tobacco education, prevention, and 
cessation grant program to provide funding for community-based and statewide tobacco 
education programs designed to reduce initiation of tobacco use by children and youth, 
promote cessation of tobacco use among youth and adults, and reduce exposure to 
secondhand smoke. Any such tobacco programs may be presented in combination with 
other substance abuse programs. The program shall be administered by the division within 
the department and coordinated with efforts pursuant to part 5 of article 35 of title 24, 
C.R.S. The state board shall award grants to selected entities from moneys appropriated to 
the department from the tobacco education programs fund created in section 24-22-117, 
C.R.S. 

(2) The state board shall adopt rules that specify, but are not necessarily limited to, the 
following: 

(a) The procedures and timelines by which an entity may apply for program grants; 



25-3.5-804 Health Title 25 - page 190 

(b) Grant application contents; 

(c) Criteria for selecting those entities that shall receive grants and determining the 
amount and duration of said grants; 

(d) Reporting requirements for entities that receive grants pursuant to this part 8. 

(3) (a) The division shall review the applications received pursuant to this part 8 and 
make recommendations to the state board regarding those entities that may receive grants 
and the amounts of said grants. On and after October 1, 2005, the review committee shall 
review the applications received pursuant to this part 8 and submit to the state board and the 
director of the department recommended grant recipients, grant amounts, and the duration 
of each grant. Within thirty days after receiving the review committee's recommendations, 
the director shall submit his or her recommendations to the state board. The review 
committee's recommendations regarding grantees of the Tony Grampsas youth services 
program, section 25-20.5-201, pursuant to section 25-3.5-805 (5) shall be submitted to the 
state board and the Tony Grampsas youth services board. Within thirty days after receiving 
the review committee's recommendations, the Tony Grampsas youth services board shall 
submit its recommendations to the state board. The state board shall have the final authority 
to approve the grants under this part 8. If the state board disapproves a recommendation for 
a grant recipient, the review committee may submit a replacement recommendation within 
thirty days. In reviewing grant applications for programs to provide tobacco education, 
prevention, and cessation programs for persons with mental illness, the division or the 
review committee shall consult with the programs for public psychiatry at the university of 
Colorado health sciences center, the national alliance for the mentally ill, the mental health 
association of Colorado, and the department of human services. 

(b) The state board shall award grants to the selected entities, specifying the amount 
and duration of the award. No grant awarded pursuant to this part 8 shall exceed three years 
without renewal. Of the amount awarded each year pursuant to the provisions of this part 
8, the state board shall award at least one-third of the amount to entities that provide tobacco 
education, prevention, and cessation programs, solely or in combination with substance 
abuse programs, to school-age children. 

(4) In implementing the program, the division shall survey the need for trained 
teachers, health professionals, and others involved in providing tobacco education, preven- 
tion, and cessation programs. To the extent the division determines there is a need, the 
division may provide technical training and assistance to entities that receive program 
grants pursuant to this part 8. 

(5) (a) There is hereby created the tobacco education, prevention, and cessation grant 
program review committee, referred to in this part 8 as the "review committee". The review 
committee is established in the division. The review committee is responsible for ensuring 
that program priorities are established consistent with the Colorado tobacco prevention and 
control strategic plan, overseeing program strategies and activities, and ensuring that the 
program grants are in compliance with section 25-3.5-805. 

(b) The review committee shall consist of the following sixteen members: 

(I) The director of the department or the director's designee; 

(II) Five members who shall be appointed by the director of the department, one of 
whom shall include the director of the tobacco education, prevention, and cessation 
program within the division and four of whom shall be staff of the program with expertise 
in tobacco prevention among youth, reducing exposure to secondhand smoke, tobacco 
cessation, or public education. 

(III) Eight members who shall be appointed by the state board as follows: 

(A) One member who is a member of the state board; 

(B) One member who is a representative of a local public health agency; 

(C) One member who is a representative of a statewide association representing 
physicians; 

(D) One member who is a representative of an association representing family physi- 
cians; 

(E) One member who is a representative of the Colorado department of education; 

(F) One member who is a representative of the university of Colorado health sciences 
center who has expertise in evaluation; 



Title 25 - page 191 Emergency Medical and Trauma Services 25-3.5-805 

(G) One member who represents a socio-demographic disadvantaged population in 
Colorado; and 

(H) One member who is a representative of a statewide nonprofit organization with a 
demonstrated expertise in and commitment to tobacco control. 

(IV) The president of the senate shall appoint one member of the senate. 

(V) The speaker of the house of representatives shall appoint one member of the house 
of representatives. 

(c) (I) Except as provided in subparagraph (II) of this paragraph (c), members of the 
review committee shall serve three-year terms; except that of the members initially 
appointed to the review committee, five members appointed by the state board shall serve 
two-year terms. Members of the review committee appointed pursuant to subparagraph (III) 
of paragraph (b) of this subsection (5) shall not serve more than two consecutive terms. 

(II) The terms of the members appointed by the speaker of the house of representatives 
and the president of the senate and who are serving on March 22, 2007, shall be extended 
to and expire on or shall terminate on the convening date of the first regular session of the 
sixty-seventh general assembly. As soon as practicable after such convening date, the 
speaker and the president shall appoint or reappoint members in the same manner as 
provided in subparagraphs (IV) and (V) of paragraph (b) of this subsection (5). Thereafter, 
the terms of members appointed or reappointed by the speaker and the president shall expire 
on the convening date of the first regular session of each general assembly, and all 
subsequent appointments and reappointments by the speaker and the president shall be 
made as soon as practicable after such convening date. The person making the original 
appointment or reappointment shall fill any vacancy by appointment for the remainder of an 
unexpired term. Members shall serve at the pleasure of the appointing authority and shall 
continue in office until the member's successor is appointed. 

(d) The composition of the review committee shall reflect, to the extent practical, 
Colorado's ethnic, racial, and geographic diversity. 

(e) Members of the review committee shall serve without compensation but shall be 
reimbursed from moneys deposited in the tobacco education programs fund created in 
section 24-22-117, C.R.S., for their actual and necessary expenses incurred in the perfor- 
mance of their duties pursuant to this part 8. 

(f) The review committee shall elect from its membership a chair and a vice-chair of the 
committee. 

(g) The division shall provide staff support to the review committee. 

(h) If a member of the review committee has an immediate personal, private, or 
financial interest in any matter pending before the review committee, the member shall 
disclose the fact and shall not vote upon such matter. 

Source: L. 2000: Entire part added, p. 615, § 13, effective May 18. L. 2005: (1) 

amended, p. 911, § 16, effective June 2; (1) and (3)(a) amended and (5) added, p. 932, 
§ 24, effective June 2. L. 2007: (5)(c) amended, p. 187, § 23, effective March 22. 
L. 2009: (1) amended, (SB 09-292), ch. 369, p. 1970, § 86, effective August 5. 

Editor's note: Amendments to subsection (1) by House Bill 05-1261 and House Bill 05-1262 were 
harmonized. 

Cross references: For the legislative declaration contained in the 2005 act amending subsections 
(1) and (3)(a) and enacting subsection (5), see section 1 of chapter 241, Session Laws of Colorado 
2005. 

25-3.5-805. Tobacco education, prevention, and cessation programs - require- 
ments. (1) An entity that applies for a grant pursuant to the provisions of this part 8 shall 
in the application demonstrate that the tobacco education, prevention, or cessation program 
provides at least one of the following: 

(a) Education designed for school-age children that, at a minimum, addresses tobacco 
use prevention and cessation strategies and the dangers of tobacco use; or 



25-3.5-806 Health Title 25 - page 192 

(b) Education programs, including but not limited to school, work site, mass media, and 
health-care setting programs, designed to prevent or reduce the use of all types of tobacco 
products or help reduce exposure to secondhand smoke; or 

(c) Counseling regarding the use of all types of tobacco products; or 

(d) Programs that address prevention and cessation of the abuse of various types of 
drugs, with an emphasis on prevention and cessation of tobacco use; or 

(e) (Deleted by amendment, L. 2005, p. 935, § 25, effective June 2, 2005.) 

(f) Tobacco use and substance abuse prevention and cessation services addressed to 
specific population groups such as adolescents and pregnant women and provided within 
specific ethnic and low-income communities; or 

(g) Training of teachers, health professionals, and others in the field of tobacco use and 
prevention; or 

(h) Tobacco addiction prevention and treatment strategies that are designed specifically 
for persons with mental illness; or 

(i) Activities to prevent the sale or furnishing by other means of cigarettes or tobacco 
products to minors; or 

(j) Programs that are designed to eliminate health disparities among segments of the 
population that have higher than average tobacco burdens. 

(1.5) Notwithstanding the requirements of subsection (1) of this section, an entity may 
apply for a grant for the purpose of evaluating the entire statewide program or individual 
components of the program. 

(2) If the entity applying for a grant pursuant to the provisions of this part 8 is a school 
district or board of cooperative services, in addition to the information specified in 
subsection ( 1 ) of this section, the entity shall demonstrate in the application that the tobacco 
education, prevention, and cessation program to be operated with moneys received from the 
grant is a program that has not been previously provided by the school district or board of 
cooperative services. The entity shall also demonstrate that the program is specifically 
designed to appeal to and address the concerns of the age group to which the program will 
be presented. 

(3) In adopting criteria for awarding grants, the state board shall adopt such criteria as 
will ensure that the implementation of a comprehensive program is consistent with the 
Colorado tobacco prevention and control strategic plan, that tobacco education, prevention, 
and cessation programs are available throughout the state, and that the programs are 
available to serve persons of all ages. 

(4) At least fifteen percent of the moneys annually awarded to grantees pursuant to this 
section shall be for the purposes of providing funding to eliminate health disparities among 
minority populations and high-risk populations that have higher-than-average tobacco 
burdens. 

(5) Up to fifteen percent of the moneys annually awarded pursuant to this section shall 
be allocated to grantees of the Tony Grampsas youth services program, section 25-20.5-201, 
for proven tobacco prevention and cessation programs. 

(6) The majority of moneys annually awarded to grantees that qualify pursuant to 
subsections (1), (2), and (5) of this section shall be for evidence-based programs and 
programs that prevent and reduce tobacco use among youth and young adults. 

Source: L. 2000: Entire part added, p. 616, § 13, effective May 18. L. 2005: Entire 

section amended, p. 935, § 25, effective June 2. 

Cross references: For the legislative declaration contained in the 2005 act amending this section, 
see section 1 of chapter 241, Session Laws of Colorado 2005. 

25-3.5-806. Tobacco education, prevention, and cessation programs - reporting 
requirements. ( 1 ) In adopting rules specifying the reporting requirements for entities that 
receive grants pursuant to this part 8, the state board shall ensure that such reports, at a 
minimum, include: 

(a) An evaluation of the implementation of the program, including but not limited to the 
number of persons served and the services provided; 



Title 25 - page 193 Emergency Medical and Trauma Services 25-3.5-809 

(b) The results achieved by the program, specifying the goals of the program and the 
criteria used in measuring attainment of the goals; 

(c) An explanation of how the results achieved by the program contribute to the 
achievement of the program goals as stated in section 25-3.5-802. 

(2) The division shall compile the annual reports received from entities pursuant to this 
section and the department shall include the compilation and any other necessary informa- 
tion in the annual report on programs that are funded by moneys received by the state 
pursuant to the master settlement agreement prepared pursuant to section 25-1-108.5 (3). 

(3) (a) The division shall annually review the reports received from entities receiving 
grants pursuant to this part 8 and shall make recommendations to the state board concerning 
whether the amount received by an entity should be continued, reduced, or increased. The 
division may also recommend that the grant for an entity be immediately terminated or not 
renewed if the tobacco education, prevention, and cessation program funded by the grant 
does not demonstrate a sufficient level of success, as determined by the division. 

(b) The division may contract with one or more public or private entities to review and 
compile the reports received pursuant to this section and prepare the recommendations 
pursuant to paragraph (a) of this subsection (3). 

Source: L. 2000: Entire part added, p. 617, § 13, effective May 18. 

25-3.5-807. Tobacco program fund - created. (Repealed) 

Source: L. 2000: Entire part added, p. 618, § 13, effective May 18. L. 2003: (2)(a) 
amended, p. 465, § 10, effective March 5; (2)(a) amended, p. 2564, § 7, effective June 5. 
L. 2004: (2)(a) amended and (2)(b) repealed, pp. 1709, 1713, §§ 7, 16, effective June 4. 
L. 2005: Entire section repealed, p. 912, § 17, effective June 2. 

25-3.5-807.5. Transfer of balance of tobacco program fund - repeal. (Repealed) 

Source: L. 2009: Entire section added, (SB 09-208), ch. 149, p. 624, § 21, effective 
April 20. 

Editor's note: Subsection (2) provided for the repeal of this section, effective July 1, 2009. (See 
L. 2009, p. 624.) 

25-3.5-808. Administration - limitation. The prevention services division of the 
department may receive up to five percent of the moneys annually appropriated by the 
general assembly from the tobacco education programs fund created in section 24-22-117, 
C.R.S., for the actual costs incurred in administering the program, including the hiring of 
sufficient staff within the division to effectively administer the program and reimbursement 
of review committee members pursuant to section 25-3.5-804 (5). 

Source: L. 2005: Entire section added, p. 936, § 26, effective June 2. 

Cross references: For the legislative declaration contained in the 2005 act enacting this section, see 
section 1 of chapter 241, Session Laws of Colorado 2005. 

25-3.5-809. Tobacco education, prevention, and cessation programs - funding. The 

programs under this part 8 shall be funded by moneys annually appropriated by the general 
assembly to the department from the tobacco education programs fund created in section 
24-22-117, C.R.S. 

Source: L. 2005: Entire section added, p. 912, § 18, effective June 2. 

Editor's note: This section was originally numbered as § 25-3.5-808 in House Bill 05-1261 but 
has been renumbered on revision for ease of location. 



Health 
DISEASE CONTROL 



Title 25 -page 194 



ARTICLE 4 

Disease Control 

Cross references: For cancer cure control, see article 30 of title 12; for programs of the department 
of public health and environment for the control of environmental and chronic diseases, see 
§ 25-1.5-102. 



PART 1 

SANITARY REGULATIONS 

25-4-101. Premises sanitation - food de- 

fined. 

Sanitary regulations. 

Construction requirements. 

Protection from dirt. 

Toilet rooms and lavatories. 

Nuisances - misdemeanor. 

Rooms not used for sleeping. 

Work by diseased persons for- 
bidden. 
25-4-109. Enforcement. 

25-4-110. Prosecutions - disposition of 

fines. 
25-4-111. Penalty. 

25-4-112. Rules. 

PART 2 



25-4 

25-4 

25-4 

25-4 

25-4 

25-4-107 

25-4-108 



102. 
103. 
104. 
105. 
106. 



PRENATAL EXAMINATIONS 

25-4-201. 
25-4-202. 



25-4-203. 
25-4-204. 
25-4-205. 



Pregnant woman to take blood 

test. 
Tests approved by department. 

(Repealed) 
Birth certificate - blood test. 
Penalty. 
District attorneys to prosecute. 



PART 3 
BLINDNESS IN NEWLY BORN 



25-4-403. 

25-4-404. 

25-4-405. 

25-4-406. 
25-4-407. 
25-4-408. 



25-4-500.3. 
25-4-501. 



25-4-502. 
25-4-503. 

25-4-504. 

25-4-505. 

25-4-506. 

25-4-507. 

25-4-508. 
25-4-509. 
25-4-510. 
25-4-511. 



25-4-301. 


Inflammation of eyes. 




25-4-302. 


Duties of department. (Re- 
pealed) 


25-4-512. 


25-4-303. 


Duty to treat eyes. (Repealed) 


25-4-513, 


25-4-304. 


Duties of county, district, or 
municipal public health di- 
rector. (Repealed) 




25-4-305. 


Penalty. (Repealed) 






PART 4 


25-4-601, 
25-4-602, 


SEXUALLY TRANSMITTED INFECTIONS 




25-4-401. 


Sexually transmitted infections 






- definitions. 


25-4-603, 


25-4-402. 


Sexually transmitted infections 
reported - physician's immu- 






nity. 


25-4-604, 



Medicine sold only on prescrip- 
tion. (Repealed) 

Examination of suspected 
cases. 

Examination of persons con- 
fined. 

Rules - provision of services. 

Penalty. 

Distribution of information. 

PART 5 
TUBERCULOSIS 

Definitions. 

Tuberculosis declared to be an 
infectious and communicable 
disease. 

Tuberculosis to be reported. 

Examination of sputum. (De- 
leted by amendment) 

Statistical case register. (De- 
leted by amendment) 

Laboratories to report. (Deleted 
by amendment) 

Investigation and examination 
of suspected or known tuber- 
culosis cases. 

Isolation order - enforcement - 
court review. 

Inspection of records. 

Violations - penalty. 

Jurisdiction. 

Duties of board of health and 
department - confidentiality 
of records - rules. 

Nondiscrimination in the provi- 
sion of general services. 

Funding. 

PART 6 
RABIES CONTROL 

Definitions. 

Notice to health department or 
officer if animal affected or 
suspected of being affected 
by rabies. 

Report of person bitten by ani- 
mal to health department or 
health officer. 

Animal attacking or biting per- 



Title 25 - page 195 



Disease Control 



25-4-605. 

25-4-606. 
25-4-607. 

25-4-608. 
25-4-609. 
25-4-610. 



25-4-611. 
25-4-612. 
25-4-613. 



25-4-614. 
25-4-615. 



son to be confined - exami- 
nation. 

Animals bitten by animals 
known or suspected of hav- 
ing rabies to be confined. 

Animals to be confined to pre- 
vent spread of rabies. 

Order of board of health requir- 
ing inoculation of animals - 
veterinarian waiver of order 

Notice of order requiring inoc- 
ulation of animals. 

Effect of order requiring inocu- 
lation of animals. 

Uninoculated animals not to 
run at large - impounding and 
disposition of animals. 

Report to state department. 

Enforcement of part 6. 

Liability for accident or subse- 
quent disease from inocula- 
tion. 

Penalties. 

Further municipal restrictions 
not prohibited. 

PART 7 



PET ANIMAL AND PSITTACINE BIRD 
FACILITIES 

25-4-701. Definitions. 

25-4-702. Board to establish rules - de- 

partment to administer. 

25-4-703. License required - fee. (Re- 

pealed) 

25-4-704. Hobby breeders of psittacine 

birds. (Repealed) 

25-4-705. Importation for resale prohib- 

ited - when. (Repealed) 

25-4-706. Pet animal and psittacine bird 

dealers - duties. (Repealed) 

25-4-707. Psittacine birds - sale or trans- 

fer - requirements. (Re- 
pealed) 

25-4-708. Nonpsittacine birds - when reg- 

ulated. (Repealed) 

25-4-709. Quarantine. 

25-4-710. Right of entry - inspections. 

25-4-7 1 1 . Suspension or revocation of li- 

cense. (Repealed) 

25-4-712. Unlawful acts. 

25-4-713. Penalty for violations - assess- 

ments. 

25-4-714. Exemptions from part 7. (Re- 

pealed) 

25-4-715. Repeal of sections - review of 

functions. (Repealed) 

PARTS 

PHENYLKETONURIA 

25-4-801. Legislative declaration. 



25-4-802. Tests for metabolic defects. 

25-4-803. Rules and regulations. 

25-4-804. Exceptions. 

PART 9 

SCHOOL ENTRY IMMUNIZATION 



25-4-901. 


Definitions. 


25-4-902. 


Immunization prior to attend- 




ing school - standardized im- 




munization information. 


25-4-902.5. 


Immunization prior to attend- 




ing a college or university - 




tuberculosis screening pro- 




cess development. 


25-4-903. 


Exemptions from immuniza- 




tion. 


25-4-904. 


Rules and regulations - immu- 




nization rules - rule-making 




authority of state board of 




health. 


25-4-905. 


Immunization of indigent chil- 




dren. 


25-4-906. 


Certificate of immunization - 




forms. 


25-4-907. 


Noncompliance. 


25-4-908. 


When exemption from immuni- 




zation not recognized. 


25-4-909. 


Vaccine-related injury or death 




- limitations on liability. 




PART 10 



NEWBORN SCREENING AND GENETIC 
COUNSELING AND EDUCATION ACT 



25-4-1001. 
25-4-1002. 
25-4-1003. 



25-4-1004. 
25-4-1004.5. 



25-4-1004.7. 



25-4-1005. 
25-4-1006. 



25-4-1101 to 
25-4-1111. 



Short title. 

Legislative declaration. 

Powers and duties of executive 
director - newborn screening 
programs - genetic counsel- 
ing and education programs - 
rules. 

Newborn screening. 

Follow-up testing and treat- 
ment - second screening - 
legislative declaration - fee - 
rules. 

Newborn hearing screening - 
legislative declaration - advi- 
sory committee - report - 
rules - repeal. 

Exceptions. 

Cash funds. 

PART 11 
KENNELS 



(Repealed) 



Health 



Title 25 - page 196 



PART 12 
STREPTOCOCCUS CONTROL 

25-4-1201. 
25-4-1202. 

PART 13 



Powers and duties of executive 

director. 
Streptococcus cash fund. 



RETAIL FOOD STORE SANITATION ACT 

25-4-1301. Legislative declaration. 

25-4-1302. Definitions. 

25-4-1303. Labeling - product modules - 

take-home containers. 

25-4-1304. Bulk food protection. 

25-4-1305. Bulk food display. 

25-4-1306. Dispensing utensils. 

25-4-1307. Materials. 

25-4-1308. Food-contact surfaces. 

25-4-1309. Non-food-contact surfaces. 

25-4-1310. Accessibility. 

25-4-1311. Equipment sanitization. 

25-4-1312. Violation - penalty. 

25-4-1313. Rules and regulations. 

25-4-1314. Limitation. 

PART 14 

HIV INFECTION AND ACQUIRED 
IMMUNE DEFICIENCY SYNDROME 

25-4-1401. Legislative declaration. 

25-4-1402. Reports of HIV infection. 

25-4-1402.5. Exemption from reporting. 
(Repealed) 

25-4-1403. Reports of positive HIV tests. 

25-4-1404. Use of reports. 

25-4-1405. Disease control by the state de- 

partment of public health and 
environment and county, dis- 
trict, and municipal public 
health agencies. 

25-4-1405.5. Extraordinary circumstances - 
procedures. 

25-4-1406. Public health procedures for 

persons with HIV infection. 

25-4-1407. Emergency public health pro- 

cedures. 

25-4-1408. Rules and regulations. 

25-4-1408.5. Eligibility for services. 

25-4-1409. Penalties. 

25-4-1410. Repeal of part. (Repealed) 

25-4-1411. AIDS drug assistance program 

- legislative declaration - no 
entitlement created. 

25-4-1412. Definitions. 

25-4-1413. Program. 

25-4-1414. Grant program - conflict of in- 

terest. 

25-4-1415. Cash fund - administration - 

limitation. 



PART 15 

BREAST CANCER SCREENING 

25-4-1501. Legislative declaration. 

25-4-1502. Definitions. 

25-4-1503. Fund created. 

25-4- 1 504. Allocation of fund. 

25-4-1505. Powers and duties of depart- 
ment and advisory board. 

25-4-1506. Repeal of part. (Repealed) 

PART 16 

FOOD PROTECTION ACT 

25-4-1601. Legislative declaration. 

25-4-1602. Definitions. 

25-4-1603. Licensing, certification, and 

food protection agency. 

25-4-1604. Powers and duties of depart- 

ment - rules. 

25-4-1605. Submission of plans for ap- 

proval - required. 

25-4-1606. Licensure - exception. 

25-4-1607. Fees - repeal. 

25-4-1608. Food protection cash fund - 

creation. 

25-4-1609. Disciplinary actions - closure - 

revocation - suspension - re- 
view. 

25-4-1609.5. Grievance process. 

25-4-1610. Unlawful acts. 

25-4-1611. Violation - penalties. 

25-4-1612. Judicial review. 

25-4-1613. General fund moneys - repeal. 

25-4-1614. Home kitchens - exemption - 

food inspection - short title - 
definitions. 

PART 17 

INFANT IMMUNIZATION ACT 

25-4-1701. Short title. 

25-4-1702. Legislative declaration. 

25-4-1703. Definitions. 

25-4-1704. Infant immunization program - 

delegation of authority to im- 
munize minor. 

25-4-1705. Department of public health 

and environment - powers 
and duties - rules. 

25-4-1706. Infant immunization program - 

eligibility. 

25-4-1707. Moneys targeted for medical 

assistance for infants - reim- 
bursement. 

25-4-1708. Fund created. 

25-4-1709. Limitations on liability. 

25-4- 1710. Report to the general assembly. 

(Repealed) 



Title 25 -page 197 



Disease Control 



25-4-101 



25-4-1711. Infant immunization advisory 

committee - creation. (Re- 
pealed) 

PART 18 

SHELLFISH DEALER CERTIFICATION 
ACT 

25-4-1801. Short title. 

25-4-1802. Legislative declaration. 

25-4-1803. Definitions. 

25-4- 1 804. Department designated as certi- 

fying and inspecting agency. 

25-4-1805. Powers and duties of depart- 

ment - rules. 

25-4- 1 806. Shellfish dealers - certificate re- 

quired - application - fees. 

25-4-1807. Record-keeping requirements. 

25-4-1808. Unlawful acts. 

25-4-1809. Inspections - investigations - 

access - subpoena. 

25-4-1810. Enforcement. 

25-4-1811. Disciplinary actions - denial of 

certification. 

25-4-1812. Civil penalties. 

25-4-1813. Criminal penalties. 

PART 19 

GULF WAR SYNDROME 
REGISTRY 

25-4-1901. Short title. 

25-4-1902. Definitions. 

25-4-1903. Gulf war syndrome registry - 

creation - reporting. 
25-4-1904. Gulf war syndrome advisory 

committee - creation. 
25-4-1905. Confidentiality of information 

collected. 
25-4-1906. Gulf war syndrome registry 

fund. 

PART 20 

HEPATITIS C EDUCATION 
AND SCREENING PROGRAM 

25-4-2001. Short title. 

25-4-2002. Legislative declaration. 

25-4-2003. Definitions. 

25-4-2004. Powers and duties of executive 

director - hepatitis C pro- 
gram. 



PART 21 

BODY ARTISTS 

25-4-2101. Powers and duties of depart- 

ment - rules. 
25-4-2102. Penalties for violations. 

25-4-2103. Parental consent for minors. 

PART 22 

HEALTH DISPARITIES GRANT PROGRAM 



Legislative declaration. 

Definitions. 

Health disparities grant pro- 
gram - rules. 

Office of health disparities - 
creation. 

Powers and duties of office of 
health disparities. 

Minority health advisory com- 
mission - creation - repeal. 

Interagency health disparities 
leadership council - creation. 

PART 23 



COLORADO IMMUNIZATION FUND 



25-4-2201. 
25-4-2202. 
25-4-2203. 

25-4-2204. 

25-4-2205. 

25-4-2206. 

25-4-2207. 



25-4-2301. 



Colorado immunization fund - 
supplemental tobacco litiga- 
tion settlement moneys ac- 
count - creation. 

PART 24 



IMMUNIZATION REGISTRY ACT 

25-4-2401. Short title. 

25-4-2402. Legislative declaration. 

25-4-2403. Department of public health 

and environment - powers 
and duties - immunization 
tracking system. 

PART 25 

CERVICAL CANCER IMMUNIZATION 
ACT 

25-4-2501. Short title. 

25-4-2502. Definitions. 

25-4-2503. Cervical cancer immunization 

program - rules. 
25-4-2504. Public awareness campaign - 

fund. 



PART 1 
SANITARY REGULATIONS 



25-4-101. Premises sanitation - food defined. Every building, room, basement, en- 
closure, or premises occupied, used, or maintained as a bakery, confectionery, cannery, 



25-4-102 Health Title 25 - page 198 

packing house, slaughterhouse, creamery, cheese factory, restaurant, hotel, grocery, meat 
market factory, shop, or warehouse, or any public place or manufacturing place used for the 
preparation, manufacture, packing, storage, sale, or distribution of any food, as defined in 
this section, which is intended for sale shall be properly and adequately lighted, drained, 
plumbed, and ventilated and shall be conducted with strict regard to the influence of such 
conditions upon the health of operatives, employees, clerks, or other persons therein 
employed and the purity and wholesomeness of the food therein produced, prepared, 
manufactured, packed, stored, sold, or distributed. For the purposes of this part 1, "food" 
includes all articles used for food, drink, confectionery, or condiment, whether simple, 
mixed, or compound, and all substances or ingredients used in the preparation thereof. 

Source: L. 13: p. 510, § 1. C.L. § 1015. CSA: C. 69, § 21. CRS 53: § 66-13-1. 
C.R.S. 1963: § 66-13-1. 

Cross references: For safety inspections, see articles 1 and 4 of title 9; for the "Slaughter, 
Processing, and Sale of Meat Animals Act", see article 33 of title 35. 

ANNOTATION 

Law reviews. For article, "Impact of the 
Uniform Commercial Code on Colorado Law", 
see 42 Den. L. Ctr. J. 67 (1965). 

25-4-102. Sanitary regulations. The floors, sidewalls, ceilings, furniture, receptacles, 
utensils, dishes, implements, and machinery of every restaurant, hotel kitchen, and estab- 
lishment or place where such food intended for sale is produced, prepared, manufactured, 
packed, stored, sold, or distributed and all cars, trucks, and vehicles used in the transpor- 
tation of such food products shall at no time be kept or permitted to remain in an unclean, 
unhealthful, or unsanitary condition. For the purpose of this part 1, unclean, unhealthful, 
and unsanitary conditions shall be deemed to exist if food in the process of production, 
preparation, manufacture, packing, storage, sale, distribution, or transportation is not 
securely protected from flies, dust, dirt, and all other foreign or injurious contamination, as 
far as may be necessary by all reasonable means; or if the refuse, dirt, or waste products 
incident to the manufacture, preparation, packing, selling, distributing, or transportation of 
such food are not removed daily; or if all trucks, trays, boxes, buckets, or other receptacles 
or the chutes, platforms, racks, tables, shelves, and knives, saws, cleavers, or other utensils, 
or the machinery used in moving, handling, cutting, chopping, mixing, canning, or other 
processes are not thoroughly cleaned daily; or if the clothing of operatives, employees, 
clerks, or other persons therein employed is unclean; or if all dishes, cups, glasses, knives, 
forks, and spoons are not thoroughly washed in hot or running water and rinsed after each 
usage; or if dishes, cups, or glasses are used which are so cracked, chipped, or broken as 
to be detrimental to health; or if all ice-cream cones and straws are not securely covered. 

Source: L. 13: p. 511, § 2. L. 21: p. 675, § 1. C.L. § 1016. CSA: C. 69, § 22. 
CRS 53: § 66-13-2. C.R.S. 1963: § 66-13-2. 

25-4-103. Construction requirements. The sidewalls, floors, and ceilings of every 
bakery, confectionery, creamery, cheese factory, and hotel or restaurant kitchen and every 
building, room, basement, or enclosure occupied or used for the preparation, manufacture, 
packing, storage, sale, or distribution of food shall be so constructed that they can easily be 
kept clean. 

Source: L. 13: p. 511, § 3. C.L. § 1017. CSA: C. 69, § 23. CRS 53: § 66-13-3. 
C.R.S. 1963: § 66-13-3. 



Title 25 - page 199 Disease Control 25-4-108 

25-4-104. Protection from dirt. All such factories, buildings, and other places con- 
taining food shall be provided with proper doors and screens necessary and adequate to 
protect against the contamination of the product from flies, dust, or dirt. 

Source: L. 13: p. 511, § 4. L. 21: p. 676, § 2. C.L. § 1018. CSA: C. 69, § 24. 
CRS 53: § 66-13-4. C.R.S. 1963: § 66-13-4. 

25-4-105. Toilet rooms and lavatories. Every such building, room, basement, enclo- 
sure, or premises occupied, used, or maintained for the production, preparation, manufac- 
ture, canning, packing, storage, sale, or distribution of such food shall have adequate and 
convenient toilet rooms or lavatories. The toilet rooms shall be separate and apart from the 
rooms where the process of production, preparation, manufacture, packing, storing, can- 
ning, selling, and distributing is conducted. The floors of such toilet rooms shall be of 
cement, tile, wood, brick, or other nonabsorbent material and shall be washed and scoured 
daily. Such toilets shall be furnished with separate ventilating flues and pipes discharging 
into soil pipes or shall be on the outside of and well removed from the building. Lavatories 
and washrooms shall be maintained in a sanitary condition. 

Source: L. 13: p. 511, § 5. C.L. § 1019. CSA: C. 69, § 25. CRS 53: § 66-13-5. 
C.R.S. 1963: § 66-13-5. 

25-4-106. Nuisances - misdemeanor. If any such building, room, basement, enclosure, 
or premises occupied, used, or maintained for the purposes stated in sections 25-4-101 to 
25-4-105 or if the floors, sidewalls, ceilings, furniture, receptacles, utensils, implements, 
appliances, or machinery of any such establishment shall be constructed, kept, maintained, 
or permitted to remain in a condition contrary to any of the provisions of sections 25-4-101 
to 25-4-105, the same is declared a nuisance. Any toilet room, lavatory, or washroom which 
shall be constructed, kept, maintained, or permitted to remain in a condition contrary to the 
requirements of section 25-4-105 is declared a nuisance. Any car, truck, or vehicle used in 
the moving or transportation of any food product which shall be kept or permitted to remain 
in an unclean, unhealthful, or unsanitary condition is declared a nuisance. Whoever 
unlawfully maintains, or allows or permits to exist, a nuisance as defined in this section is 
guilty of a misdemeanor and, upon conviction thereof, shall be punished as provided in 
section 25-4-111. 

Source: L. 13: p. 512, § 6. L. 21: p. 677, § 3. C.L. § 1020. CSA: C. 69, § 26. 
CRS 53: § 66-13-6. C.R.S. 1963: § 66-13-6. 

25-4-107. Rooms not used for sleeping. It is unlawful for any person to sleep or to 
allow or permit any person to sleep in any workroom of a bakeshop, kitchen, dining room, 
confectionery, creamery, cheese factory, or other place where food is prepared for sale, 
served, or sold unless all foods therein handled are at all times in hermetically sealed 
packages. 

Source: L. 13: p. 512, § 7. C.L. § 1021. CSA: C. 69, § 27. CRS 53: § 66-13-7. 
C.R.S. 1963: § 66-13-7. 

25-4-108. Work by diseased persons forbidden. It is unlawful for any employer to 
permit any person who works in food preparation and is affected with any contagious or 
infectious disease that is spread by food to work, or for any person so affected to work, in 
any capacity in which there is a likelihood that the employee would contaminate food or 
food-contact surfaces with pathogenic organisms or transmit disease to other persons. 

Source: L. 13: p. 512, § 8. C.L. § 1022. CSA: C. 69, § 28. CRS 53: § 66-13-8. 
C.R.S. 1963: § 66-13-8. L. 2009: Entire section amended, (SB 09-179), ch. 112, p. 467, 
§ 1, effective April 9. 



25-4-109 Health Title 25 - page 200 

25-4-109. Enforcement. (1) It is the duty of the department of public health and 
environment to enforce this part 1, and, for that purpose, the department has full power at 
all times to enter every such building, room, basement, enclosure, or premises occupied or 
used or suspected of being occupied or used for the production, preparation, or manufacture 
for sale, or the storage, sale, distribution, or transportation of such food, to inspect the 
premises and all utensils, fixtures, furniture, and machinery used pursuant to the provisions 
of this subsection (1), Any refusal to permit such inspection shall be deemed a violation of 
this part 1. If upon inspection any such food producing or distributing establishment, 
conveyance, or employer, employee, clerk, driver, or other person is found to be violating 
any of the provisions of this part 1 , or if the production, preparation, manufacture, packing, 
storage, sale, distribution, or transportation of such food is being conducted in a manner 
detrimental to the health of the employees and operatives or to the character or quality of 
the food therein produced, prepared, manufactured, packed, stored, sold, distributed, or 
conveyed, the department of public health and environment shall issue a written order to the 
person, firm, or corporation responsible for the violation or condition to abate such 
condition or violation or to make such changes or improvements as may be necessary to 
abate them within a reasonable time. Notice of such order may be served by delivering a 
copy thereof to said person, firm, or corporation or by sending a copy thereof by registered 
mail, and the receipt thereof through the post office shall be prima facie evidence that notice 
of said order has been received. 

(2) Such person, firm, or corporation has the right to appear in person or by attorney 
before the department of public health and environment, or the person appointed by it for 
such purpose, within the time limited in the order and shall be given an opportunity to be 
heard and to show why such order or instructions should not be obeyed. Such hearing shall 
be under such rules and regulations as may be prescribed by the department. If after such 
hearing it appears that the provisions or requirements of this part 1 have not been violated, 
said order shall be rescinded. If it appears that the requirements or provisions of this part 
1 are being violated and that the person, firm, or corporation notified is responsible therefor, 
said previous order shall be confirmed or amended, as the facts shall warrant, and shall 
thereupon be final, but such additional time as is necessary may be granted within which to 
comply with said final order. If such person, firm, or corporation is not present or 
represented when such final order is made, notice thereof shall be given as provided in 
subsection (1) of this section. Upon failure of the parties to comply with the first order of 
the department within the time prescribed when no hearing is demanded or upon failure to 
comply with the final order within the time specified, the department of public health and 
environment shall certify the facts to the district attorney of the county in which such 
violation occurred, and such district attorney shall proceed against the parties for the fines 
and penalties provided by this part 1 and also for the abatement of the nuisance. The 
proceedings prescribed in this section for the abatement of nuisance as defined in section 
25-4-106 shall not in any manner relieve the violator from prosecution in the first instance 
for any such violation or from the penalties for such violation prescribed by section 
25-4-111. 

Source: L. 13: p. 513, § 9. L. 21: p. 677, § 4. C.L. § 1023. CSA: C. 69, § 29. 
CRS 53: § 66-13-9. C.R.S. 1963: § 66-13-9. L. 94: Entire section amended, p. 2758, 
§ 423, effective July 1. 

Cross references: For the legislafive declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-110. Prosecutions - disposition of fines. All fines collected under the provisions 
of this part 1 shall be paid to the county treasurer of the county in which the prosecution 
is brought, and it is the duty of the district attorneys in the respective counties to prosecute 
all persons violating or refusing to obey the provisions of this part 1 . 

Source: L. 13: p. 514, § 10. C.L. § 1024. CSA: C. 69, § 30. CRS 53: § 66-13-10. 
C.R.S. 1963: § 66-13-10. 



Title 25 - page 201 Disease Control 25-4-202 

25-4-111. Penalty. Any person who violates any of the provisions of this part 1 or 
refuses to comply with any lawful order or requirement of the department of public health 
and environment, duly made in writing as provided in section 25-4-109, is guilty of a 
misdemeanor and, upon conviction thereof, shall be punished for the first offense by a fine 
of not more than two hundred dollars and for the second and subsequent offenses by a fine 
of not more than two hundred dollars, or by imprisonment in the county jail for not more 
than ninety days, or by both such fine and imprisonment. Each day of noncompliance after 
the expiration of the time limit for abating unsanitary conditions and completing improve- 
ments to abate such conditions, as ordered by the department of public health and 
environment, constitutes a separate offense. 

Source: L. 13: p. 514, § 11. L. 21: p. 679, § 5. C.L. § 1025. CSA: C. 69, § 31. 
CRS 53: § 66-13-11. C.R.S. 1963: § 66-13-11. L. 94: Entire section amended, p. 2759, 
§ 424, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-112. Rules. The state board of health, created in section 25-1-103, may adopt 
rules as necessary for the implementation of this article. 

Source: L. 2009: Entire section added, (SB 09-179), ch. 1 12, p. 467, § 2, effective April 
9. 

PART 2 

PRENATAL EXAMINATIONS 

25-4-201. Pregnant woman to take blood test. (1) Every licensed health care 
provider authorized to provide care to a pregnant woman in this state for conditions relating 
to her pregnancy during the period of gestation or at delivery shall take or cause to be taken 
a sample of blood of the woman at the time of the first professional visit or during the first 
trimester for testing pursuant to this section. The blood specimen obtained shall be 
submitted to an approved laboratory for a standard serological test for syphilis and HIV. 
Every other person permitted by law to attend pregnant women in this state but not 
permitted by law to take blood samples shall cause a sample of blood of each pregnant 
woman to be taken by a licensed health care provider authorized to take blood samples and 
shall have the sample submitted to an approved laboratory for a standard serological test for 
syphilis and HIV. A pregnant woman may decline to be tested as specified in this subsection 
(1), in which case the licensed health care provider shall document that fact in her medical 
record. 

(2) If a pregnant woman entering a hospital for delivery has not been tested for HIV 
during her pregnancy, the hospital shall notify the woman that she will be tested for HIV 
unless she objects and declines the test. If the woman declines to be tested, the hospital shall 
document that fact in the pregnant woman's medical record. 

Source: L. 39: p. 413, § 1. CSA: C. 78, § 170(1). CRS 53: § 66-11-1. C.R.S. 1963: 

§ 66-11-1. L. 2009: Entire section amended, (SB 09-179), ch. 112, p. 467, § 3, effective 
April 9. 

25-4-202. Tests approved by department. (Repealed) 

Source: L. 39: p. 413, § 2. CSA: C. 78, § 170(2). CRS 53: § 66-11-2. C.R.S. 1963: 

§ 66-11-2. L. 94: Entire section amended, p. 2760, § 425, effective July 1. L. 2009: 
Entire section repealed, (SB 09-179), ch. 112, p. 468, § 4, effective April 9. 



25-4-203 Health Title 25 - page 202 

25-4-203. Birth certificate - blood test. In reporting every birth and stillbirth, physi- 
cians and others required to make such reports shall state on the certificate whether a blood 
test for syphilis and HIV has been made upon a specimen of blood taken from the woman 
who bore the child for which a birth or stillbirth certificate is filed and the approximate date 
when the specimen was taken. In no event shall the birth certificate state the result of the 
test. 

Source: L. 39: p. 413, § 3. CSA: C. 78, § 170(3). CRS 53: § 66-11-3. C.R.S. 1963: 
§ 66-11-3. L. 2009: Entire section amended, (SB 09-179), ch. 112, p. 468, § 5, effective 
April 9. 

Cross references. For a certificate of birth, see § 25-2-112. 

25-4-204. Penalty. Any licensed physician and surgeon or other person engaged in 
attendance upon a pregnant woman during the period of gestation or at delivery or any 
representative of a laboratory who violates the provisions of this part 2 is guilty of a 
misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than 
three hundred dollars. Every licensed physician and surgeon or other person engaged in 
attendance upon a pregnant woman during the period of gestation or at delivery who 
requests such specimen in accordance with the provisions of section 25-4-201 and whose 
request is refused is not guilty of a misdemeanor. 

Source: L. 39: p. 414, § 4. CSA: C. 78, § 170(4). CRS 53: § 66-11-4. C.R.S. 1963: 

§ 66-11-4. 

25-4-205. District attorneys to prosecute. The district attorneys in the several districts 
in the state shall prosecute for violation of this part 2 as for other crimes and misdemeanors. 

Source: L. 39: p. 414, § 5. CSA: C. 78, § 170(5). CRS 53: § 66-11-5. C.R.S. 1963: 

§ 66-11-5. 

PART 3 
BLINDNESS IN NEWLY BORN 

25-4-301. Inflammation of eyes. (1) Any inflammation, swelling, or unusual redness 
in either one or both eyes of any infant, either apart from or together with any unnatural 
discharge from the eyes of such infant, independent of the nature of the infection, if any, 
occurring at any time within two weeks after the birth of such infant shall be known as 
"inflammation of the eyes of the newly bom" (ophthalmia neonatorum). 

(2) It is the duty of any physician, nurse, or other person who assists or is in charge at 
the birth of an infant or is charged with the care of the infant after birth to treat the eyes of 
the infant with a prophylaxis in accordance with current standard of care. Such treatment 
shall be given as soon as practicable after the birth of the infant and always within one hour. 
If any redness, swelling, inflammation, or gathering of pus appears in the eyes of such 
infant, or upon the lids or about the eyes, within two weeks after birth, any person charged 
with care of the infant shall report the same to some competent practicing physician or 
advanced practice nurse within six hours after its discovery. 

(3) Nothing in this section requires medical treatment for the minor child of any person 
who is a member of a well-recognized church or religious denomination and whose 
religious convictions, in accordance with the tenets or principles of his or her church or 
religious denomination, are against medical treatment for disease. 

Source: L. 37: p. 618, § 1. CSA: C. 22, § 69. CRS 53: § 66-6-1. C.R.S. 1963: 

§ 66-6-1. L. 2012: (2) and (3) added, (HB 12-1058), ch. 71, p. 244, § 1, effective March 
24. 



Title 25 - page 203 Disease Control 25-4-402 

25-4-302. Duties of department. (Repealed) 

Source: L. 37: p. 618, § 2. CSA: C. 22, § 70. CRS 53: § 66-6-2. C.R.S. 1963: 
§ 66-6-2. L. 77: (l)(d) and (l)(e) amended, p. 284, § 49, effective July 1. L. 94: IP(1) and 
(l)(c) amended, p. 2760, § 426, effective July 1. L. 2010: (l)(c) amended, (HB 10-1422), 
ch. 419, p. 2093, § 90, effective August 11. L. 2012: Entire section repealed, (HB 
12-1058), ch. 71, p. 244, § 2, effective March 24. 

25-4-303. Duty to treat eyes. (Repealed) 

Source: L. 37: p. 619, § 3. CSA: C. 22, § 71. CRS 53: § 66-6-3. C.R.S. 1963: 
§ 66-6-3. L. 77: Entire part added, p. 284, § 50, effective July 1. L. 94: Entire section 
amended, p. 2760, § 427, effective July 1. L. 2012: Entire section repealed, (HB 12-1058), 
ch. 71, p. 245, § 3, effective March 24. 

25-4-304. Duties of county, district, or municipal public health director. (Repealed) 

Source: L. 37: p. 619, § 4. CSA: C. 22, § 72. CRS 53: § 66-6-4. C.R.S. 1963: 
§ 66-6-4. L. 2010: IP(1) amended, (HB 10-1422), ch. 419, p. 2093, § 91, effective August 
ILL. 2012: Entire section repealed, (HB 12-1058), ch. 71, p. 245, § 4, effective March 24. 

25-4-305. Penalty. (Repealed) 

Source: L. 37: p. 620, § 5. CSA: C. 22, § 73. CRS 53: § 66-6-5. C.R.S. 1963: 
§ 66-6-5. L. 77: Entire section amended, p. 285, § 51, effective July 1. L. 2012: Entire 
section repealed, (HB 12-1058), ch. 71, p. 245, § 5, effective March 24. 

PART 4 

SEXUALLY TRANSMITTED INFECTIONS 

25-4-401. Sexually transmitted infections - definitions. (1) As used in this part 4: 

(a) "Department" means the department of public health and environment created in 
section 25-1-102. 

(b) "Health officer" means the executive director of the department, the chief medical 
officer appointed pursuant to section 25-1-105, or a county or district public health director. 

(c) "Sexually transmitted infection" means syphilis, gonorrhea, and any other type of 
sexually transmitted infection designated by the state board by rule as contagious, upon 
making a finding that the particular sexually transmitted infection is contagious; except that 
cases of AIDS, HIV-related illness, and HIV infections shall be governed solely by the 
requirements of part 14 of this article. 

(d) "State board" means the state board of health created in section 25-1-103. 

(2) Sexually transmitted infections are declared to be contagious, sexually transmitted, 
and dangerous to the public health. 

(3) It is unlawful for any person who has knowledge or reasonable grounds to suspect 
that he or she is infected with a sexually transmitted infection to willfully expose to or infect 
another person with the sexually transmitted infection or to knowingly perform an act that 
exposes or infects another person to or with a sexually transmitted infection. 

Source: L. 19: p. 247, § 1. C.L. § 1075. CSA: C. 78, § 163. L. 47: p. 519, § 1. 
CRS 53: § 66-9-1. C.R.S. 1963: § 66-9-1. L. 91: (1) amended, p. 945, § 3, effective 
May 6. L. 2009: Entire section amended, (SB 09-179), ch. 112, p. 468, § 6, effective April 
9. 

25-4-402. Sexually transmitted infections reported - physician's immunity. 

(1) Any physician, intern, or other person who makes a diagnosis in, prescribes for, or 



25-4-403 Health Title 25 - page 204 

treats a sexually transmitted infection and any superintendent or manager of a state, county, 
or city hospital, dispensary, or charitable or penal institution in which there is a sexually 
transmitted infection shall make a report of such infection to the health authorities in 
accordance with the provisions of section 25-1-122 (1). 

(2) (Deleted by amendment, L. 91, p. 945, § 4, effective May 6, 1991.) 

(3) Reports of sexually transmitted infection shall be made in accordance with the 
requirements set forth in section 25-1-122 (1). 

(4) Any physician, upon consultation by a minor as a patient and with the consent of 
the minor patient, may make a diagnostic examination for sexually transmitted infection and 
may prescribe for and treat the minor patient for sexually transmitted infection without the 
consent of or notification to the parent or guardian of the minor patient or to any other 
person having custody of or parental responsibilities with respect to the minor patient. In 
any such case, the physician shall not be civilly or criminally liable for making the 
diagnostic examination or rendering the treatment, but the immunity from liability shall not 
apply to any negligent acts or omissions of the physician. 

Source: L. 19: p. 248, § 3. C.L. § 1077. L. 25: p. 420, § 1. CSA: C. 78, § 165. 
CRS 53: § 66-9-2. C.R.S. 1963: § 66-9-2. L. 67: p. 287, § 1. L. 91: Entire section 
amended, p. 945, § 4, effective May 6. L. 98: (4) amended, p. 1411, § 78, effective 
February 1, 1999. L. 2009: (1), (3), and (4) amended, (SB 09-179), ch. 112, p. 469, § 7, 
effective April 9. 

ANNOTATION 

Law reviews. For article, "Consent to Applied in Denver Publishing Co. v. Dreyfus, 

Treatment and Access to Minors' Medical Re- 184 Colo. 288, 520 R2d 104 (1974). 
cords", see 17 Colo. Law. 1323 (1988). 

25-4-403. Medicine sold only on prescription. (Repealed) 

Source: L. 19: p. 248, § 4. C.L. § 1078. L. 25: p. 421, § 2. CSA: C. 78, § 166. 
L. 47: p. 519, § 2. CRS 53: § 66-9-3. C.R.S. 1963: § 66-9-3. L. 2008: (l)(a) and (2) 
amended, p. 131, § 12, effective January 1, 2009. L. 2009: Entire section repealed, (SB 
09-179), ch. 112, p. 474, § 18, effective April 9. 

25-4-404. Examination of suspected cases. (1) Health officers or their authorized 
assistants or deputies within their respective jurisdictions are directed, when in their 
judgment it is necessary to protect the public health, to: 

(a) Require a person reasonably suspected of having a sexually transmitted infection to 
be examined and to detain the person until the results of the examination are known; 

(b) Require the examiner to give a written report of the examination to the confining 
health officer; 

(c) Require persons with sexually transmitted infections to report for treatment to a 
qualified physician and continue treatment until cured; and 

(d) Isolate persons with sexually transmitted infections. 

(2) The examination and treatment of any person with a sexually transmitted infection 
shall be conducted by a qualified physician of the person's own choice, but, if the person 
is unable to retain a private physician, he or she shall submit to examination and treatment 
provided at public expense. 

(3) It is the duty of all health officers to investigate sources of sexually transmitted 
infection, to cooperate with the proper officials whose duty it is to enforce laws directed 
against prostitution, and otherwise to use every proper means for the repression of 
prostitution. 

Source: L. 19: p. 249, § 5. C.L. § 1079. CSA: C. 78, § 167. CRS 53: § 66-9-4. 
L. 59: p. 477, § 1. C.R.S. 1963: § 66-9-4. L. 2009: Entire section amended, (SB 
09-179), ch. 112, p. 469, § 8, effective April 9. 



Title 25 - page 205 Disease Control 25-4-407 

25-4-405. Examination of persons confined. (1) All persons who are confined, 
detained, or imprisoned in any state, county, or city hospital or institution for persons with 
mental illness, any home for dependent children, any reformatory or prison, or any private 
or charitable institution where any person may be confined, detained, or imprisoned by 
order of court in this state shall be examined for and, if infected, treated for sexually 
transmitted infections by the health authorities having jurisdiction. The managing author- 
ities of any such institutions are directed to make available to the health authorities such 
portion of their respective institutions as may be necessary for a clinic or hospital, wherein 
all persons who may be confined or detained or imprisoned in any such institution and who 
are infected with sexually transmitted infections may be treated in a manner as prescribed 
by the appropriate health officer. 

(2) (Deleted by amendment, L. 2009, (SB 09-179), ch. 112, p. 470, § 9, effective April 
9, 2009.) 

Source: L. 19: p. 250, § 6. L. 21: p. 657, § 1. C.L. § 1080. CSA: C. 78, § 168. 
CRS 53: § 66-9-5. C.R.S. 1963: § 66-9-5. L. 75: (1) amended, p. 929, § 38, effective 
July 1. L. 79: (1) amended, p. 1639, § 46, effective July 19. L. 85: (1) amended, p. 710, 
§ 9, effective March 30. L. 94: Entire section amended, p. 2760, § 428, effective July 1. 
L. 2005: (1) amended, p. 281, § 16, effective August 8. L. 2006: (1) amended, p. 1405, 
§ 65, effective August 7. L. 2008: (2) amended, p. 131, § 13, effective January 1, 2009. 
L. 2009: Entire section amended, (SB 09-179), ch. 112, p. 470, § 9, effective April 9. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-406. Rules - provision of services. ( 1 ) The department, through the state board, 
shall adopt rules it deems necessary to carry out the provisions of this part 4, including rules 
providing for the control and treatment of persons isolated under section 25-4-405 and other 
rules not in conflict with this part 4 that the department deems advisable concerning the 
control of sexually transmitted infection and the care, treatment, and isolation of persons 
with sexually transmitted infections. The rules shall be binding upon all public health 
agencies, health officers, and other persons affected by this part 4 and shall have the force 
and effect of law. 

(2) Notwithstanding any other provision of this part 4 to the contrary, programs and 
services that provide for the investigation, identification, testing, preventive care, or 
treatment of sexually transmitted infections shall be available to a person regardless of his 
or her race, religion, gender, sexual orientation, ethnicity, national origin, or immigration 
status. 

Source: L. 19: p. 250, § 7. C.L. § 1081. CSA: C. 78, § 169. CRS 53: § 66-9-6. 
C.R.S. 1963: § 66-9-6. L. 94: Entire section amended, p. 2761, § 429, effective July 1. 
L. 2006, 1st Ex. Sess.: Entire section amended, p. 25, § 3, effective July 31. L. 2009: 
Entire section amended, (SB 09-179), ch. 112, p. 471, § 10, effective April 9. 

Cross references: For the legislative declarafion contained in the 1994 act amending this secfion, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 

Law reviews. For article, "2006 Immigration 
Legisladon in Colorado", see 35 Colo. Law. 79 
(October 2006). 

25-4-407. Penalty. (1) Except as provided in subsection (2) of this section, any 
person, firm, or corporation that violates a provision of this part 4, other than section 
25-4-408, or any lawful rule adopted by the state board pursuant to the authority granted in 
this part 4, or fails or refuses to obey any lawful order issued by any health officer pursuant 



25-4-408 Health Title 25 - page 206 

to the authority granted in this part 4, is guilty of a misdemeanor and, upon conviction 
thereof, shall be punished by a fine of not more than three hundred dollars, or by 
imprisonment in the county jail for not more than ninety days, or by both such fine and 
imprisonment. 

(2) If the person who commits a violation of this part 4 or a lawful rule of the state 
board or who fails or refuses to obey a lawful order of a health officer is a licensed or 
certified health care professional, the health officer may bring an action in the district court 
of the judicial district in which the violation or failure or refusal occurs to seek a civil 
penalty of not more than three hundred dollars per violation, failure, or refusal. A person 
subject to the penalties specified in this subsection (2) shall not be subject to the penalties 
described in subsection ( 1 ) of this section. 

Source: L. 19: p. 251, § 8. C.L. § 1082. CSA: C. 78, § 170. CRS 53: § 66-9-7. 
C.R.S. 1963: § 66-9-7. L. 83: Entire section amended, p. 1057, § 3, effective July 1. 
L. 94: Entire section amended, p. 2761, § 430, effective July 1. L. 2009: Entire section 
amended, (SB 09-179), ch. 112, p. 471, § 11, effective April 9. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-408. Distribution of information. The department shall prepare, for free distri- 
bution among the residents of the state, printed information and instructions concerning the 
dangers of sexually transmitted infections, their prevention, and the necessity for treatment. 
It is the duty of every physician who, during the course of an examination, discovers the 
existence of a sexually transmitted infection or who treats a person for a sexually 
transmitted infection to inform the person about the measures for preventing the spread of 
the infection and the necessity for treatment until cured, when appropriate. 

Source: L. 83: Entire section added, p. 1057, § 2, effective July 1. L. 94: Entire section 
amended, p. 2761, § 431, effective July 1. L. 2009: Entire section amended, (SB 09-179), 
ch. 112, p. 472, § 12, effective April 9. 

Cross references: For the legislative declaration contained in the 1994 act amending this secdon, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

PART 5 

TUBERCULOSIS 

Editor's note: This part 5 was numbered as article 12 of chapter 66, C.R.S. 1963. The substantive 
provisions of this part 5 were repealed and reenacted in 1967, resulting in the addition, relocation, and 
elimination of secfions as well as subject matter. For amendments to this part 5 prior to 1967, consult 
the Colorado statutory research explanatory note beginning on page vii in the front of this volume. 

25-4-500.3. Definitions. As used in this part 5, unless the context otherwise requires: 

(1) "Active tuberculosis" means a diagnosis of tuberculosis demonstrated by chnical, 
bacteriologic, or diagnostic imaging evidence, or a combination thereof. A person who has 
been diagnosed as having active tuberculosis and has not completed a course of antituber- 
culosis treatment is still considered to have active tuberculosis and may be infectious. 

(2) "Board of health" means the state board of health created in section 25-1-103. 

(3) "Contact" means a person who has shared the same air space with a person who has 
active tuberculosis. 

(4) "Contagious" means having a disease that may be transmitted from one living 
person to another through direct or indirect contact. 

(5) "Department" means the department of public health and environment. 

(6) "Health officer" means the executive director of the department, the state chief 
medical officer, and county or district public health directors. 



Title 25 - page 207 Disease Control 25-4-502 

(7) "Infectious" means contagious. 

(8) "Isolation" means separation of a person infected, or suspected to be infected, with 
tuberculosis from other persons to prevent the spread of tuberculosis. 

(9) "Latent tuberculosis infection" means that tuberculosis organisms are present in a 
person's body, but the person does not have tuberculosis or symptoms, nor is the person 
infectious. Such a person usually has a positive reaction to the tuberculin skin test. 

(10) "Local health officer" means the chief medical health officer of a county, district, 
or municipal public health agency or the health officer for a public health nursing service. 

(11) "Multidrug-resistant tuberculosis" means tuberculosis caused by tuberculosis 
organisms that are resistant to at least the drugs isoniazid and rifampin. 

(12) "Screening" means measures used to identify persons who have active tubercu- 
losis or latent tuberculosis infection. 

(13) "State chief medical officer" means the chief medical officer of the department, as 
described in section 25-1-105, or the executive director of the department. 

(14) "Suspected case of active tuberculosis", "suspected case of tuberculosis", "sus- 
pected tuberculosis", or "suspected tuberculosis case" means a diagnosis of tuberculosis is 
being considered for a person, whether or not antituberculosis therapy has been started. 

(15) "Tubercle baciUi" means tuberculosis organisms. 

(16) "Tuberculosis" means a potentially fatal contagious disease caused by the bacte- 
rial microorganisms of the mycobacterium tuberculosis complex that can affect almost any 
part of the body but most commonly affects the lungs. 

Source: L. 2008: Entire part amended, p. 313, § 1, effective April 7; (13) amended, p. 
1906, § 99, effective August 5. L. 2009: (6) amended, (SB 09-179), ch. 112, p. 472, § 13, 
effective April 9. L. 2010: (10) amended, (HB 10-1422), ch. 419, p. 2093, § 92, effective 
August 11. 

25-4-501. Tuberculosis declared to be an infectious and communicable disease. It 

is hereby declared that tuberculosis is an infectious and communicable disease, that it 
endangers the population of this state, and that the treatment and control of such disease is 
a state and local responsibility. It is further declared that the emergence of multidrug- 
resistant tuberculosis requires that this threat be addressed with a coherent and consistent 
strategy in order to protect the public health. To the end that tuberculosis may be brought 
better under control and multidrug-resistant tuberculosis prevented, it is further declared 
that the department and local public health agencies shall, within available resources, 
cooperatively promote control and treatment of persons suffering from tuberculosis. 

Source: L. 67: R&RE, p. 723, § 1. C.R.S. 1963: § 66-12-1. L. 73: p. 695, § 1. 
L. 94: Entire section amended, p. 2762, § 432, effective July 1. L. 2002: Entire section 
amended, p. 1313, § 1, effective August 7. L. 2008: Entire part amended, p. 313, § 1, 
effective April 7. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-502. Tuberculosis to be reported. (1) Every attending physician and other 
persons either treating or having knowledge of active or suspected tuberculosis in this state 
shall make a report to the department in accordance with section 25-1-122 (1) on every 
person known by said physician or other person to have active or suspected tuberculosis. 

(2) Any health care facility or other similar private or public institution in this state 
shall make a report to the department in accordance with section 25-1-122 (1) on every 
person having active or suspected tuberculosis who comes into its care or observation. 

(3) All clinical laboratories rendering diagnostic service shall report to the department 
in accordance with section 25-1-122 (1), within twenty-four hours after diagnosis, the full 
name and other available data relating to the person whose sputa or other specimens 
submitted for examination reveal the presence of tubercle bacilli. 



25-4-503 Health Title 25 - page 208 

Source: L. 67: R&RE, p. 723, § 1. C.R.S. 1963: § 66-12-2. L. 91: Entire section 
amended, p. 946, § 5, effective May 6. L. 94: (1) and (2) amended, p. 2762, § 433, 
effective July 1. L. 2008: Entire part amended, p. 315, § 1, effective April 7. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(1) and (2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-503. Examination of sputum. (Deleted by amendment) 

Source: L. 67: R&RE, p. 724, § 1. C.R.S. 1963: § 66-12-3. L. 94: Entire section 
amended, p. 2762, § 434, effective July 1. L. 2008: Entire part amended, p. 315, § 1, 
effective April 7. 

Editor's note: This section was deleted by amendment in 2008. (See L. 2008, p. 315.) 

25-4-504. Statistical case register. (Deleted by amendment) 

Source: L. 67: R&RE, p. 724, § 1. C.R.S. 1963: § 66-12-4. L. 94: Entire section 
amended, p. 2763, § 435, effective July 1. L. 2008: Entire part amended, p. 315, § 1, 
effective April 7. 

Editor's note: This section was deleted by amendment in 2008. (See L. 2008, p. 315.) 

25-4-505. Laboratories to report. (Deleted by amendment) 

Source: L. 67: R&RE, p. 724, § 1. C.R.S. 1963: § 66-12-5. L. 94: Entire section 
amended, p. 2763, § 436, effective July 1. L. 2008: Entire part amended, p. 316, § 1, 
effective April 7. 

Editor's note: This section was deleted by amendment in 2008. (See L. 2008, p. 316.) 

25-4-506. Investigation and examination of suspected or known tuberculosis cases. 

( 1 ) The state chief medical officer and all local health officers are directed to use every 
available means to investigate immediately and ascertain the existence of all reported or 
suspected cases of active tuberculosis within the health officer's jurisdiction, to determine 
the sources of such infections, and to identify and evaluate the contacts of such cases and 
offer treatment as appropriate. In carrying out such investigations, such health officer is 
invested with full powers of inspection and examination of all persons known to be infected 
with active tuberculosis and is directed to make or cause to be made such examinations as 
are deemed necessary of persons who, on reasonable grounds, are suspected of having 
active tuberculosis in an infectious form. 

(2) Whenever a health officer determines on reasonable grounds that an examination of 
any person is necessary for the preservation and protection of the public health, the health 
officer shall issue a written order directing medical examination, setting forth the name of 
the person to be examined, the time and place of the examination, and such other terms and 
conditions as the health officer may deem necessary. A copy of such order shall be served 
upon the person. Such an examination may be made by a licensed physician or advanced 
practice nurse of the person's own choice under such terms and conditions as the health 
officer shall specify. 

(3) Any person who depends exclusively on prayer for healing in accordance with the 
teachings of any well-recognized religious sect, denomination, or organization, and claims 
exemptions on such grounds, shall nevertheless be subject to examination, and the provi- 
sions of this part 5 regarding compulsory reporting of communicable diseases and isolations 
shall apply where there is probable cause to suspect that such person has active tuberculosis. 
Such person shall not be required to submit to any medical treatment or to go to or be 



Title 25 - page 209 Disease Control 25-4-507 

confined in a hospital or other medical institution if the person can safely be isolated in the 
person's own home or other suitable place of the person's choice. 

(4) A health officer may conduct screening programs of populations that are at 
increased risk of developing tuberculosis or having latent tuberculosis infection and offer 
treatment as appropriate. Such screening programs may be implemented by a local health 
officer with the approval of the state chief medical officer. 

Source: L. 67: R&RE, p. 724, § 1. C.R.S. 1963: § 66-12-6. L. 2002: (1) amended, p. 
1313, § 2, effective August 7. L. 2004: (l)(a) amended, p. 1201, § 66, effective August 4. 
L. 2008: Entire part amended, p. 316, § 1, effective April 7; (2) amended, p. 132, § 14, 
effective January 1, 2009. 

Editor's note: Amendments to subsecdon (2) by House Bill 08-1061 and House Bill 08-1 199 were 
harmonized, effective January 1, 2009. 

25-4-507. Isolation order - enforcement - court review. (1) (a) Whenever a health 
officer determines that isolation of a person in a particular tuberculosis case is necessary for 
the preservation and protection of the public health, the health officer shall make an 
isolation order in writing. 

(b) When a health officer is determining whether to issue an isolation order for a 
person, the health officer shall consider, but is not limited to, the following factors: 

(1) Whether the person has active tuberculosis; 

(II) If the person is violating the rules promulgated by the board of health or the orders 
issued by the appropriate health officer to comply with rules or orders; and 

(III) Whether the person presents a substantial risk of exposing other persons to an 
imminent danger of infection. 

(c) All isolation orders shall set forth the name of the person to be isolated and the 
initial period, not to exceed six months, during which the order shall remain effective, the 
place of isolation, and such other terms and conditions as may be immediately necessary to 
protect the public health. The isolation order shall advise the person being detained that he 
or she has the right to request release from detention by contacting a person designated in 
the order and that the detention shall not continue for more than five business days after the 
request for release, unless the detention is authorized by court order. The health officer shall 
serve a copy of the isolation order upon the person. The person shall be reexamined at the 
time the initial order expires to ascertain whether or not the tuberculous condition continues 
to be infectious. When it has been medically determined that the person no longer has active 
tuberculosis, the person shall be relieved from all further liability or duty imposed by this 
part 5, and the health officer shall rescind the order. 

(d) A health officer may detain a person who is the subject of an isolation order issued 
pursuant to this subsection (1) without a prior court order. The health officer may detain the 
person in a hospital or other appropriate place for examination or treatment. 

(2) In a case of a person with multidrug-resistant tuberculosis, the health officer may 
issue an isolation order to such person if it is determined that the person has ceased taking 
prescribed medications against medical advice. Such order may be issued even if the person 
is no longer contagious so long as the person has not completed an entire course of therapy. 

(3) (a) If a person detained pursuant to an isolation order requests to be released, the 
detaining authority shall release the person not later than five business days after the person 
requests the release, absent a court order authorizing detention. Upon receipt of a request 
for release, the detaining authority shall apply for a court order authorizing continued 
detention of the person. The detaining authority shall make the application within seventy- 
two hours after the person requests release or, if the seventy-two-hour period ends on a 
Saturday, Sunday, or legal holiday, by the end of the first business day following the 
Saturday, Sunday, or legal holiday. The application shall include a request for an expedited 
hearing. 

(b) In any court proceeding to enforce an isolation order, the health officer shall prove 
the particular circumstances constituting the necessity for the detention by clear and 



25-4-508 Health Title 25 - page 2 1 

convincing evidence. Any person who is subject to an isolation order has the right to be 
represented by counsel and, upon request, counsel shall be provided to the person. 

(c) The request for release or filing of an application for a court order to continue an 
isolation order shall not stay the isolation order. 

(d) In reviewing the application to continue the isolation order, the court shall not 
conduct a de novo review. The court shall consider the existing administrative record and 
any supplemental evidence the court deems relevant. 

(e) Upon completion of the hearing, the court shall issue an order continuing, modi- 
fying, or dismissing the isolation order. 

(f) A hearing conducted pursuant to this section shall be closed and confidential, and 
any transcripts relating to the hearing shall be confidential. 

Source: L. 67: R&RE, p. 725, § 1. C.R.S. 1963: § 66-12-7. L. 2002: (3) added, p. 
1314, § 3, effective August 7. L. 2008: Entire part amended, p. 317, § 1, effective April 
7. L. 2009: (l)(c) amended and (l)(d) and (3) added, (SB 09-179), ch. 112, pp. 472, 473, 
§§ 14, 15, effective April 9. 

25-4-508. Inspection of records. Authorized department personnel may inspect and 
have access to all medical records of all medical practitioners, hospitals, institutions, and 
clinics, both public and private, where persons with known or suspected tuberculosis are 
treated and shall provide consultation services regarding the control of tuberculosis and the 
care of persons having tuberculosis to health care providers or any other persons having 
responsibility for the care of persons with tuberculosis. Authorized department personnel 
shall also have access to laboratory records of persons tested for tuberculosis. 

Source: L. 67: R&RE, p. 725, § 1. C.R.S. 1963: § 66-12-8. L. 91: Entire section 
amended, p. 947, § 6, effective May 6. L. 94: Entire section amended, p. 2763, § 437, 
effective July 1. L. 2008: Entire part amended, p. 318, § 1, effective April 7. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see secfion 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-509. Violations - penalty. ( 1 ) Any person who, after service upon him or her of 
an order of a health officer directing his or her isolation or examination as provided in 
sections 25-4-506 and 25-4-507, violates or fails to comply with the order is guilty of a 
misdemeanor and, upon conviction thereof, in addition to any and all other penalties that 
may be imposed by law upon such convictions, the court may make an appropriate order 
providing for examination, isolation, or treatment. 

(2) Any person, firm, or corporation that fails to make the reports required by this part 
5 or knowingly makes any false report is guilty of a misdemeanor and, upon conviction 
thereof, shall be punished by a fine of not more than five hundred dollars. 

(3) Upon the receipt of information that any examination, isolation, or treatment order 
made and served as provided in this part 5 has been violated, the health officer shall advise 
the district attorney of the judicial district in which such violation occurred of the pertinent 
facts relating to the violation. 

Source: L. 67: R&RE, p. 725, § 1. C.R.S. 1963: § 66-12-9. L. 2008: Entire part 
amended, p. 318, § 1, effective April 7. 

25-4-510. Jurisdiction. District courts shall have original jurisdiction under this part 5. 

Source: L. 67: R&RE, p. 726, § 1. C.R.S. 1963: § 66-12-10. L. 2008: Entire part 
amended, p. 318, § 1, effective April 7. 

Editor's note: This section was not amended in 2008, although it was contained in a 2008 act that 
amended this entire part 5. 



Title 25 - page 2 1 1 Disease Control 25-4-5 1 3 

25-4-511. Duties of board of health and department - confidentiaUty of records - 
rules. (1) The board of health is authorized to adopt such rules as are deemed necessary, 
appropriate, and consistent with good medical practice in the state of Colorado for the 
treatment and control of persons with tuberculosis. 

(2) Subject to available appropriations, the department may contract with local public 
health agencies to provide assistance with tuberculosis treatment and control. The depart- 
ment shall retain the authority to, when necessary: 

(a) Direct any program of investigation and examination of suspected tuberculosis 
cases, including persons who have had contact with a person who has suspected or 
confirmed active tuberculosis, and the administration of antituberculosis chemotherapy or 
the treatment of a latent tuberculosis infection on an outpatient basis where appropriate; 

(b) Perform such other duties and have such other powers with relation to the 
provisions, objects, and purposes of this part 5 as the board of health shall prescribe. 

(3) Except as otherwise provided by law, all records kept by the department and by 
local public health agencies and all records retained in a county coroner's office in 
accordance with section 30-10-606 (4) (c), C.R.S., as a result of the investigation of 
tuberculosis shall be kept strictly confidential and shall only be shared to the extent 
necessary for the investigation, treatment, control, and prevention of tuberculosis; except 
that every effort shall be made to limit disclosure of personal identifying information to the 
minimal amount necessary to accomplish the public health purpose. 

Source: L. 73: p. 695, § 2. C.R.S. 1963: § 66-12-11. L. 94: (l)(a), IP(2), and (3) 
amended, p. 2763, § 438, effective July 1. L. 2002: (2)(a) and (2)(b) amended, p. 1314, 
§ 4, effective August 7. L. 2008: Entire part amended, p. 318, § 1, effective April 7. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(l)(a), the introductory portion to subsection (2), and subsection (3), see section 1 of chapter 345, 
Session Laws of Colorado 1994. 

25-4-512. Nondiscrimination in the provision of general services. Notwithstanding 
any other provision of this part 5 to the contrary, programs and services that provide for the 
investigation, identification, testing, preventive care, or treatment of tuberculosis shall be 
available to a person regardless of his or her race, religion, gender, ethnicity, national origin, 
or immigration status. 

Source: L. 73: p. 696, § 2. C.R.S. 1963: § 66-12-12. L. 2002: Entire section 
amended, p. 1314, § 5, effective August 7. L. 2006 1st Ex. Sess.: (l)(c) amended and (2) 
added, p. 26, § 4, effective July 31. L. 2008: Entire part amended, p. 319, § 1, effective 
April 7. 

ANNOTATION 

Law reviews. For article, "2006 Immigration 
Legislation in Colorado", see 35 Colo. Law. 79 
(October 2006). 

25-4-513. Funding. The department shall provide funding to local public health 
agencies for tuberculosis treatment and control and shall consider the number of active, 
suspected, and latent tuberculosis cases undergoing therapy in each agency's jurisdiction 
when determining funding levels. 

Source: L. 73: p. 696, § 2. C.R.S. 1963: § 66-12-13. L. 2008: Entire part amended, 
p. 320, § 1, effective April 7. 



25-4-601 Health Title 25 - page 212 

PART 6 
RABIES CONTROL 

25-4-601. Definitions. As used in this part 6, unless the context otherwise requires: 

(1) "County board of health" means the body acting as the county or district board of 
health under the provisions of section 25-1-508. 

(2) "Health department" means the department of public health and environment or 
any county or district pubhc health agency organized and maintained under the provisions 
of part 5 of article 1 of this title. 

(3) "Health officer" means the person appointed as the public health director of a 
district, county, city, or town under the provisions of section 25-1-509. 

(4) "Inoculation against rabies" means the administration of the antirabies vaccine as 
approved by the department of public health and environment or the county or district 
department of health. 

(5) "Owner" means any person who has a right of property in a dog, cat, other pet 
animal, or other mammal, or who keeps or harbors a dog, cat, other pet animal, or other 
mammal, or who has it in his care or acts as its custodian. 

Source: L. 63: p. 545, § 1. CRS 53: § 66-25-1. C.R.S. 1963: § 66-23-1. L. 91: (2) 
and (5) amended, p. 947, § 7, effective May 6. L. 94: (4) amended, p. 2764, § 439, 
effective July 1. L. 2008: (1), (2), and (3) amended, p. 2053, § 7, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(4), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-602. Notice to health department or officer if animal affected or suspected of 
being affected by rabies. Whenever a dog, cat, other pet animal, or other mammal is 
affected by rabies or suspected of being affected by rabies or has been bitten by an animal 
known or suspected to be affected by rabies, the owner of the dog, cat, other pet animal, or 
other mammal, or any person having knowledge thereof, shall forthwith notify the health 
department or health officer in the county, city, or town in which such animal is located, 
stating precisely where such animal may be found. 

Source: L. 63: p. 546, § 1. CRS 53: § 66-25-2. C.R.S. 1963: § 66-23-2. L. 91: 
Entire section amended, p. 947, § 8, effective May 6. 

25-4-603. Report of person bitten by animal to health department or health officer. 

Every physician after his first professional attendance upon a person bitten by a dog, cat, 
other pet animal, or other mammal, or any person having knowledge thereof, shall report 
to the health department or health officer in accordance with the provisions of section 

25-1-122 (1). 

Source: L. 63: p. 546, § 1. CRS 53: § 66-25-3. C.R.S. 1963: § 66-23-3. L. 91: 
Entire section amended, p. 947, § 9, effective May 6. 

25-4-604. Animal attacking or biting person to be confined - examination. The 

health department or health officer shall serve notice upon the owner of a dog, cat, other pet 
animal, or other mammal which has attacked or bitten a person to confine the animal at the 
expense of the owner upon his premises or at a pound or other place designated in the notice 
for a period designated by the department of public health and environment. The health 
department, health officer, or his representative shall be permitted by the owner of such dog, 
cat, other pet animal, or other mammal to examine the animal at any time within the period 
of confinement to determine whether such animal shows symptoms of rabies. No person 
shall obstruct or interfere with the authorized person in making such examination. 



Title 25 - page 2 1 3 Disease Control 25-4-607 

Source: L. 63: p. 546, § 1. CRS 53: § 66-25-4. C.R.S. 1963: § 66-23-4. L. 91: 
Entire section amended, p. 948, § 10, effective May 6. L. 94: Entire section amended, p. 

2764, § 440, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-605. Animals bitten by animals known or suspected of having rabies to be 
confined. The health department or health officer shall serve notice in writing upon the 
owner of a dog, cat, other pet animal, or other mammal known to have been bitten by an 
animal known or suspected of having rabies requiring the owner to immediately treat and 
confine such animal by procedures outlined by the department of public health and 
environment. 

Source: L. 63: p. 546, § 1. CRS 53: § 66-25-5. C.R.S. 1963: § 66-23-5. L. 91: 
Entire section amended, p. 948, § 11, effective May 6. L. 94: Entire section amended, p. 

2765, § 441, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-606. Animals to be confined to prevent spread of rabies. Whenever the board 
of health of a health department or the county board of health has reason to believe or has 
been notified by the department of public health and environment that there is imminent 
danger that rabies may spread within that county or district, such board shall serve public 
notice by publication in a newspaper of general circulation in such county or district 
covered by such department requiring the owners of dogs, cats, other pet animals, or other 
mammals specified to confine such dogs, cats, pet animals, or mammals for such period as 
may be necessary to prevent the spread of rabies in such county or district. 

Source: L. 63: p. 546, § 1. CRS 53: § 66-25-6. C.R.S. 1963: § 66-23-6. L. 91: 
Entire section amended, p. 948, § 12, effective May 6. L. 94: Entire section amended, p. 
2765, § 442, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-607. Order of board of health requiring inoculation of animals - veterinarian 
waiver of order. (1) (a) When it is deemed advisable in the interest of public health and 
safety, the board of health of an organized health department or a county board of health 
may order that all dogs, cats, other pet animals, or other mammals in the county or district 
be vaccinated against rabies, such vaccination to be performed by a licensed veterinarian. 

(b) Notwithstanding the provisions of paragraph (a) of this subsection (1), a board of 
health of an organized health department or a county board of health shall not order the 
inoculation of dogs, cats, or ferrets against rabies any more frequently than is recommended 
in the "Compendium of Animal Rabies Control" as promulgated by the national association 
of state public health veterinarians. 

(2) A veterinarian, with the written consent of an animal's owner, may issue a written 
waiver pursuant to the rules of the health department, exempting an animal from a rabies 
vaccination order if the veterinarian, in his or her professional opinion, determines that the 
rabies inoculation is contraindicated due to the animal's medical condition. 

(3) (a) The executive director of the health department shall enact rules allowing for 
the exemption of an animal from a rabies vaccination due to the medical condition of the 
animal. 

(b) The owner of an animal seeking an exemption from a rabies vaccination for his or 
her animal must provide the veterinarian with written consent for the exemption. 



25-4-608 Health Title 25 - page 214 

(c) A veterinarian supplying a waiver exempting an animal from a rabies vaccination, 
county, district, and municipal health departments, their assistants and employees, the 
health department, health officers, and anyone enforcing this part 6 shall not be liable for 
any subsequent accident, disease, injury, or quarantine that may occur as a result of an 
animal exempted from a rabies vaccination pursuant to the rules of the health department. 

(4) A waiver executed pursuant to this section shall be accepted and recognized by any 
local or regional authority issuing licenses for the ownership of animals. 

Source: L. 63: p. 547, § 1. CRS 53: § 66-25-7. C.R.S. 1963: § 66-23-7. L. 91: 
Entire section amended, p. 948, § 13, effective May 6. L. 99: Entire section amended, p. 
275, § 2, effective July 1. L. 2008: Entire section amended, p. 1629, § 1, effective May 
29. L. 2010: (3)(c) amended, (HB 10-1422), ch. 419, p. 2093, § 93, effective August 11. 

25-4-608. Notice of order requiring inoculation of animals. The order of a board of 
health of a health department or a county board of health requiring inoculation of all dogs, 
cats, other pet animals, or other mammals shall not become effective until twenty-four hours 
after notice of adoption of the order requiring inoculation of all dogs, cats, other pet 
animals, or other mammals has been published in a newspaper of general circulation in the 
county or district. 

Source: L. 63: p. 547, § 1. CRS 53: § 66-25-8. C.R.S. 1963: § 66-23-8. L. 91: 
Entire section amended, p. 949, § 14, effective May 6. 

25-4-609. Effect of order requiring inoculation of animals. Sections 25-4-610 and 
25-4-61 1 shall be in force and effect only in those counties, districts, or portions of counties 
or districts where an order requiring inoculation of all dogs, cats, other pet animals, or other 
mammals is in effect. 

Source: L. 63: p. 547, § 1. CRS 53: § 66-25-9. C.R.S. 1963: § 66-23-9. L. 91: 
Entire section amended, p. 949, § 15, effective May 6. 

25-4-610. Uninoculated animals not to run at large - impounding and disposition 
of animals. It is unlawful for any owner of any dog, cat, other pet animal, or other mammal 
which has not been inoculated as required by the order of the county board of health or 
board of health of a health department to allow it to run at large. The health department or 
health officer may capture and impound any such dog, cat, other pet animal, or other 
mammal found running at large and dispose of such animal in accordance with local 
program policy. Such power to impound and dispose shall extend to any and all animals 
unclaimed and found or suspected to be affected by rabies, whether wild or domestic. The 
division of parks and wildlife shall cooperate with and aid the health department or health 
officer in the enforcement of this section as it affects animals found or suspected to be 
affected by rabies when such animals are in its care, jurisdiction, or control. 

Source: L. 63: p. 547, § 1. CRS 53: § 66-25-10. C.R.S. 1963: § 66-23-10. L. 91: 
Entire section amended, p. 949, § 16, effective May 6. 

25-4-611. Report to state department. Each health department or health officer shall 
furnish information to the department of public health and environment concerning all cases 
of rabies and the prevalence of rabies within the county at any time such information is 
requested by the department of public health and environment. 

Source: L. 63: p. 548, § 1. CRS 53: § 66-25-11. C.R.S. 1963: § 66-23-11. L. 94: 
Entire section amended, p. 2765, § 443, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 



Title 25 - page 2 1 5 Disease Control 25-4-6 1 5 

25-4-612. Enforcement of part 6. The health officer or health department shall enforce 
the provisions of this part 6, and the sheriff and his deputies and the police officers in each 
incorporated municipality and the division of parks and wildlife shall be aides and are 
instructed to cooperate with the health department or health officer in carrying out the 
provisions of this part 6. 

Source: L. 63: p. 548, § 1. CRS 53: § 66-25-12. C.R.S. 1963: § 66-23-12. 

25-4-613. Liability for accident or subsequent disease from inoculation. The health 
departments, their assistants and employees, the department of public health and environ- 
ment, health officers, or anyone enforcing the provisions of this part 6 shall not be held 
responsible for any accident or subsequent disease that may occur in connection with the 
administration of this part 6. 

Source: L. 63: p. 548, § 1. CRS 53: § 66-25-13. C.R.S. 1963: § 66-23-13. L. 94: 
Entire section amended, p. 2765, § 444, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-614. Penalties. Any person who refuses to comply with or who violates any of the 
provisions of this part 6 is guilty of a misdemeanor and, upon conviction thereof, shall be 
punished by a fine of not more than one hundred dollars or by imprisonment in the county 
jail for not more than thirty days for each offense. 

Source: L. 63: p. 548, § 1. CRS 53: § 66-25-14. C.R.S. 1963: § 66-23-14. 

25-4-615. Further municipal restrictions not prohibited. (1) Nothing in this part 6 
shall be construed to limit the power of any municipality within this state to prohibit dogs 
from running at large, whether or not they have been inoculated as provided in this part 6; 
and nothing in this part 6 shall be construed to limit the power of any municipality to 
regulate and control and to enforce other and additional measures for the restriction and 
control of rabies. 

(2) Notwithstanding subsection ( 1 ) of this section, a municipality shall not require a 
dog, cat, or ferret to be inoculated against rabies any more frequently than is recommended 
in the "Compendium of Animal Rabies Control" as promulgated by the national association 
of state public health veterinarians, and a veterinarian may issue a written waiver exempting 
an animal from a rabies vaccination order as provided in section 25-4-607. 

Source: L. 63: p. 548, § 1. CRS 53: § 66-25-15. C.R.S. 1963: § 66-23-15. L. 99: 
Entire section amended, p. 275, § 3, effective July 1. L. 2008: (2) amended, p. 1630, § 2, 
effective May 29. 

Cross references: For control and licensing of dogs by counties, see part 1 of article 15 of tide 30, 
and for other municipal restrictions, see § 31-15-401 (l)(b) and (l)(m)(I). 

PART 7 

PET ANIMAL AND PSITTACINE BIRD FACILITIES 

Editor's note: This part 7 was numbered as article 19 of chapter 66, C.R.S. 1963. The substantive 
provisions of this part 7 were repealed and reenacted in 1983, resulting in the addition, relocation, and 
elimination of sections as well as subject matter. For amendments to this part 7 prior to 1983, consult 
the Colorado statutory research explanatory note and the table itemizing the replacement volumes and 
supplements to the original volume of C.R.S. 1973 beginning on page vii in the front of this volume. 
Former C.R.S. section numbers are shown in editor's notes following those sections that were 
relocated. 



25-4-70 1 Health Title 25 - page 2 1 6 

25-4-701. Definitions. As used in this part 7, unless the context otherwise requires: 

(1) "Board" means the state board of health. 

(2) "Department" means the department of public health and environment. 

(3) "Pet animal facility" means any place or premises used in whole or in part for the 
keeping of pet animals for the purpose of adoption, breeding, boarding, grooming, handling, 
selling, sheltering, trading, or transferring such animals. 

(4) "Psittacine birds" includes all birds of the order psittaciformes. 

Source: L. 83: Entire part R&RE, p. 1059, § 1, effective March 1. L. 94: Entire section 
R&RE, p. 1296, § 1, effective July 1; (2) amended, p. 2619, § 31, effective July 1. 

Editor's note: (1) This section is similar to former § 25-4-701 as it existed prior to 1983. 
(2) Amendments to this section by Senate Bill 94-023 and House Bill 94-1029 were harmonized. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-702. Board to establish rules - department to administer. ( 1 ) The board may 
establish rules that are necessary to carry out the provisions of this part 7. Such rules shall 
set forth procedures to be followed by pet animal facilities in the event of an outbreak of 
disease or quarantine. Such rules may include provisions pertaining to the breeding and sale 
of psittacine birds that are necessary to prevent or minimize the danger of transmission of 
psittacosis to handlers, the general public, and other pet birds. 

(2) This part 7 shall be administered by the department; except that county, district, and 
municipal public health agencies and animal control personnel may be authorized by the 
department to assist it in performing its powers and duties pursuant to this part 7. 

(3) (Deleted by amendment, L. 94, p. 1296, § 2, effective July 1, 1994.) 

Source: L. 83: Entire part R&RE, p. 1060, § 1, effective March 1. L. 87: (3) amended, 
p. 971, § 81, effective March 13. L. 94: Entire section amended, p. 1296, § 2, effective 
July 1. L. 2010: (2) amended, (HB 10-1422), ch. 419, p. 2093, § 94, effective August 11. 

Editor's note: This section is similar to former § 25-4-705 as it existed prior to 1983. 

25-4-703. License required - fee. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1060, § 1, effective March 1 . 

Editor's note: (1) Prior to its repeal in 1994, this section was similar to former §§ 25-4-704 and 
25-4-706 as they existed prior to 1983. 

(2) Section 25-4-715 provided for the repeal of this section effective July 1, 1994. (See L. 91, p. 
688.) 

25-4-704. Hobby breeders of psittacine birds. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1061, § 1, effective March 1. L. 94: Entire section 
repealed, p. 1313, § 17, effective July 1. 

25-4-705. Importation for resale prohibited - when. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1061, § 1, effective March 1. 

Editor's note: (1) Prior to its repeal in 1994, this section is similar to former § 25-4-703 as it 
existed prior to 1983. 

(2) Section 25-4-715 provided for the repeal of this section effective July 1, 1994. (See L. 91, p. 
688.) 



Title 25 - page 217 Disease Control 25-4-7 1 1 

25-4-706. Pet animal and psittacine bird dealers - duties. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1062, § 1, effective March 1. 

Editor's note: Section 25-4-715 provided for the repeal of this section effective July 1, 1994. (See 
L. 91, p. 688.) 

25-4-707. Psittacine birds - sale or transfer - requirements. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1062, § 1, effective March 1. L. 94: Entire section 
repealed, p. 1313, § 17, effective July 1. 

Editor's note: Prior to its repeal in 1994, this section was similar to former § 25-4-702 as it existed 
prior to 1983. 

25-4-708. Nonpsittacine birds - when regulated. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1063, § 1, effective March 1. 

Editor's note: (1) Prior to its repeal in 1994, this section was similar to former § 25-4-717 as it 
existed prior to 1983. 

(2) Section 25-4-715 provided for the repeal of this section effective July 1, 1994. (See L. 91, p. 
688.) 

25-4-709. Quarantine. If at any time it appears to the department that any pet animal 
is, or was during its lifetime, infected with a disease dangerous to the public health, it may 
place an embargo on said pet animal and may trace, or cause to be traced, the whereabouts 
of said animal and determine the identity and whereabouts of any other animals which may 
have been exposed to such disease. If the department determines that the interest of the 
public health requires, it may: Cause any pet animal facility to be quarantined for such time 
as the department determines to be necessary to protect the public health; prohibit the sale 
or importation into this state of such pet animals from such places or areas where such 
danger exists; and require the euthanasia and the proper disposal of infected animals. 

Source: L. 83: Entire part R&RE, p. 1063, § 1, effective March 1. L. 94: Entire section 
amended, p. 1297, § 3, effective July 1. 

Editor's note: This section is similar to former § 25-4-710 as it existed prior to 1983. 

25-4-710. Right of entry - inspections. It is lawful for any employee of the depart- 
ment, any employee of any county, district, or municipal public health agency or animal 
control agency authorized by the department, or any authorized official of the United States 
department of agriculture when conducting an official disease investigation of a pet animal 
facility to enter such facility and to inspect the same, any animals, or any health or 
transaction records relating to the investigation. 

Source: L. 83: Entire part R&RE, p. 1063, § 1, effective March 1. L. 94: Entire section 
amended, p. 1297, § 4, effective July 1. L. 2010: Entire section amended, (HB 10-1422), 
ch. 419, p. 2094, § 95, effective August 11. 

Editor's note: This section is similar to former § 25-4-711 as it existed prior to 1983. 

25-4-711. Suspension or revocation of license. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1063, § 1, effective March 1. 



25-4-712 Health Title 25 - page 218 

Editor's note: (1) Prior to its repeal in 1994, this section was similar to former §§ 25-4-713 and 
25-4-715 as they existed prior to 1983. 

(2) Section 25-4-715 provided for the repeal of this section effective July 1, 1994. (See L. 91, p. 
688.) 

25-4-712. Unlawful acts. (1) It is unlawful for any person: 

(a) To make a material misstatement or provide false information to the department 
during an official disease investigation; 

(b) To violate a provision of this part 7 or a rule promulgated pursuant to this part 7; 

(c) To aid or abet another in a violation of this part 7 or a rule promulgated pursuant 
to this part 7; 

(d) To refuse to permit entry or inspection in accordance with section 25-4-710. 

(e) to (k) (Deleted by amendment, L. 94, p. 1298, § 5, effective July 1, 1994.) 

Source: L. 83: Entire part R&RE, p. 1063, § 1, effective March 1. L. 94: Entire section 
amended, p. 1298, § 5, effective July 1. 

25-4-713. Penalty for violations - assessments. (1) Any person who violates any of 
the provisions of this part 7 is guilty of a class 2 misdemeanor and shall be punished as 
provided in section 18-1.3-501, C.R.S. 

(2) (Deleted by amendment, L. 94, p. 1299, § 6, effective July 1, 1994.) 

Source: L. 83: Entire part R&RE, p. 1064, § 1, effective March 1. L. 94: Entire section 
amended, p. 1299, § 6, effective July 1. L. 2002: (1) amended, p. 1536, § 265, effective 
October 1. 

Editor's note: This section is similar to former § 25-4-716 as it existed prior to 1983. 

Cross references: For the legislative declaration contained in the 2002 act amending this section, 
see section 1 of chapter 318, Session Laws of Colorado 2002. 

25-4-714. Exemptions from part 7. (Repealed) 

Source: L. 83: Entire part R&RE, p. 1065, § 1, effective March 1. L. 94: Entire section 
repealed, p. 1313, § 17, effective July 1. 

25-4-715. Repeal of sections - review of functions. (Repealed) 

Source: L. 88: Entire section added, p. 930, § 14, effective April 28. L. 91: Entire 
section amended, p. 688, § 54, effective April 20. L. 94: Entire section amended, p. 1299, 
§ 7, effective July 1. L. 97: Entire section repealed, p. 1023, § 43, effective August 6. 

PART 8 

PHENYLKETONURIA 

25-4-801. Legislative declaration. The general assembly declares that, as a matter of 
public policy of this state and in the interest of public health, every newborn infant should 
be tested for phenylketonuria and other metabolic defects in order to prevent mental 
retardation resulting therefrom and that the people of this state should be extensively 
informed as to the nature and effects of such defects. 

Source: L. 65: p. 721, § 1. C.R.S. 1963: § 66-27-1. 

25-4-802. Tests for metabolic defects. ( 1 ) It is the duty of either the chief medical 
staff officer or other person in charge of each institution caring for newborn infants or, if a 



Title 25 -page 219 Disease Control 25-4-804 

newborn infant is not bom in an institution or is discharged therefrom prior to the time 
prescribed for the taking of the specimen designated in this section, the person responsible 
for the signing of the birth certificate of such child to cause to be obtained from every such 
infant a specimen of the type designated by the state board of health, which specimen shall 
be forwarded to the department of public health and environment or other laboratory 
approved by it for testing for phenylketonuria and testing for such other metabolic defects 
which may be prescribed from time to time by the state board of health to be conducted with 
respect to such specimen. 

(2) The state board of health has the duty to prescribe from time to time effective tests 
and examinations designed to detect phenylketonuria and such other metabolic disorders or 
defects likely to cause mental retardation as accepted medical practice indicates. 

(3) The performance of such tests and the reporting of results shall be done at such 
times and places and in such manner as may be prescribed by the department of public 
health and environment. 

(4) It is the duty of the department of public health and environment to contact as soon 
as possible all cases suspected of having any such disorders or defects and to do any 
additional testing required to confirm or disprove the suspected disorder or defect. 

Source: L. 65: p. 721, § 2. C.R.S. 1963: § 66-27-2. L. 94: (1), (3), and (4) amended, 
p. 2765, § 446, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(1), (3), and (4), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-803. Rules and regulations. (1) The state board of health shall promulgate 
rules and regulations concerning the obtaining of samples or specimens from newborn 
infants required for the tests prescribed by the state board of health for the handling and 
delivery of the same and for the testing and examination thereof to detect phenylketonuria 
or other metabolic disorders found likely to cause mental retardation. 

(2) The department of public health and environment shall furnish all physicians, 
public health nurses, hospitals, maternity homes, county departments of social services, and 
the state department of human services available medical information concerning the nature 
and effects of phenylketonuria and other metabolic disorders and defects found likely to 
cause mental retardation. 

Source: L. 65: p. 722, § 3. C.R.S. 1963: § 66-27-3. L. 94: (2) amended, p. 2766, 
§ 447, effective July 1. 

Cross references: For the legislative declaradon contained in the 1994 act amending subsection 
(2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-804. Exceptions. Nothing in the provisions of this part 8 shall be construed to 
require the testing or medical treatment for the minor child of any person who is a member 
of a well-recognized church or religious denomination and whose religious convictions in 
accordance with the tenets or principles of his church or religious denomination are against 
medical treatment for disease or physical defects. 

Source: L. 65: p. 722, § 4. C.R.S. 1963: § 66-27-4. 

PART 9 
SCHOOL ENTRY IMMUNIZATION 

Editor's note: This part 9 was numbered as article 40 of chapter 66, C.R.S. 1963. The substantive 
provisions of this part 9 were repealed and reenacted in 1978, resulting in the addition, relocation, and 
elimination of sections as well as subject matter. For amendments to this part 9 prior to 1978, consult 
the Colorado statutory research explanatory note and the table itemizing the replacement volumes and 



25-4-901 Health Title 25 - page 220 

supplements to the original volume of C.R.S. 1973 beginning on page vii in the front of this volume. 
Former C.R.S. section numbers are shown in editor's notes following those sections that were 
relocated. 

25-4-901. Definitions. As used in this part 9, unless the context otherwise requires: 

(1) "Certificate of immunization" means one of the following forms of documentation 
that include the dates and types of immunizations administered to a student: 

(a) A paper document that includes information transferred from the records of a 
licensed physician, registered nurse, or public health official; or 

(b) An electronic file or a hard copy of an electronic file provided to the school directly 
from the immunization tracking system, established pursuant to section 25-4-2403. 

(1.5) "Child" means any student less than eighteen years of age. 

(2) (a) "School" means, except as otherwise provided in paragraph (b) of this sub- 
section (2), a public, private, or parochial nursery school, day care center, child care facility, 
family child care home, foster care home, head start program, kindergarten, elementary or 
secondary school through grade twelve, or college or university. 

(b) "School" does not include: 

(1) A public services short-term child care facility as defined in section 26-6-102 (6.7), 
C.R.S.; 

(1.5) A guest child care facility as defined in section 26-6-102 (5), C.R.S., or a ski 
school as defined in section 26-6-103.5 (6), C.R.S.; or 

(II) College or university courses of study that are offered off-campus, or are offered to 
nontraditional adult students, as defined by the governing board of the institution, or are 
offered at colleges or universities that do not have residence hall facilities. 

(3) "Student" means any person enrolled in a Colorado school as defined in subsection 
(2) of this section. 

Source: L. 78: Entire part, R&RE, p. 427, § 1, effective April 4. L. 91: Entire section 
amended, p. 931, § 1, effective April 16. L. 92: Entire section amended, p. 1273, § 1, 
effective April 9. L. 96: (2) amended, p. 266, § 20, effective July 1. L. 98: (1) amended 
and (1.5) added, p. 19, § 1, effective August 5. L. 2007: (l)(b) amended, p. 664, § 7, 
effective April 26; (2) amended, p. 867, § 5, effective May 14. 

Editor's note: This section is similar to former § 25-4-901 as it existed prior to 1978. 

25-4-902. Immunization prior to attending school - standardized immunization 
information. (1) Except as provided in section 25-4-903, no child shall attend any school 
in the state of Colorado on or after the dates specified in section 25-4-906 (4) unless he or 
she has presented the following to the appropriate school official: 

(a) An up-to-date certificate of immunization from a licensed physician, a licensed 
advanced practice nurse, or authorized representative of the department of public health and 
environment or county, district, or municipal public health agency stating that the child has 
received immunization against communicable diseases as specified by the state board of 
health, based on recommendations of the advisory committee on immunization practices of 
the United States department of health and human services or the American academy of 
pediatrics; or 

(b) A written authorization signed by one parent or guardian or an authorization signed 
by the emancipated child requesting that local health officials administer the immunizations. 

(c) (Deleted by amendment, L. 97, p. 408, § 1, effective July 1, 1997.) 

(2) If the student's certificate of immunization is not up-to-date according to the 
requirements of the state board of health, the parent or guardian or the emancipated student 
or the student eighteen years of age or older shall submit to the school, within fourteen days 
after receiving direct personal notification that the certificate is not up-to-date, documen- 
tation that the next required immunization has been given and a written plan for completion 
of all required immunizations. The scheduling of immunizations in the written plan shall 
follow medically recommended minimum intervals approved by the state board of health. 



Title 25 - page 221 Disease Control 25-4-902.5 

If the student begins but does not continue or complete the written plan, he or she shall be 
suspended or expelled pursuant to this part 9. 

(3) Notwithstanding the provisions of subsection (1) of this section, a school shall 
enroll a student who is in out-of-home placement within five school days after receiving the 
student's education information and records as required in section 22-32-138, C.R.S., 
regardless of whether the school has received the items specified in subsection ( 1 ) of this 
section. Upon enrolling the student, the school shall notify the student's legal guardian that, 
unless the school receives the student's certificate of immunization or a written authoriza- 
tion for administration of immunizations within fourteen days after the student enrolls, the 
school shall suspend the student until such time as the school receives the certificate of 
immunization or the authorization. 

(4) On or before March 1, 201 1, the department of public health and environment shall 
develop and provide to the department of education a standardized document regarding 
childhood immunizations. The department of education shall post the standardized immu- 
nization document on its web site on or before January 15, 2011, and each year thereafter. 
The standardized document shall be updated annually and shall include, but need not be 
limited to: 

(a) A list of the immunizations required for enrollment in a school and the age at which 
the immunization is required; and 

(b) A list of immunizations currently recommended for children by the center for 
disease control advisory committee on immunization practices and the recommended age at 
which each immunization should be given. 

(5) The document created pursuant to subsection (4) of this section shall comply with 
the provisions of section 25-4-903 (4) regarding allowable exemptions from required 
immunizations. 

Source: L. 78: Entire part R&RE, p. 427, § 1, effective April 4. L. 94: Entire section 
amended, p. 2766, § 448, effective July 1. L. 95: Entire section amended, p. 916, § 14, 
effective May 25. L. 97: Entire section amended, p. 408, § 1, effective July 1. L. 2008: 
(3) added, p. 472, § 4, effective April 17; (l)(a) amended, p. 132, § 15, effective January 
1, 2009. L. 2010: (l)(a) amended, (HB 10-1422), ch. 419, p. 2094, § 96, effective August 
11; (4) and (5) added, (SB 10-056), ch. 50, p. 192, § 5, effective August 11. 

Editor's note: This section is similar to former § 25-4-902 as it existed prior to 1978. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration contained 
in the 2008 act enacting subsecdon (3), see section 1 of chapter 147, Session Laws of Colorado 2008. 

25-4-902.5. Immunization prior to attending a college or university - tuberculosis 
screening process development. (1) Except as provided in section 25-4-903, no student 
shall attend any college or university in the state of Colorado on or after the dates specified 
in section 25-4-906 (4) unless such student can present to the appropriate official of the 
school a certificate of immunization from a licensed physician, a licensed advanced practice 
nurse, or authorized representative of the department of public health and environment or 
county, district, or municipal public health agency stating that the student has received 
immunization against communicable diseases as specified by the state board of health or a 
written authorization signed by one parent or guardian or the emancipated student or the 
student eighteen years of age or older requesting that local health officials administer the 
immunizations or a plan signed by one parent or guardian or the emancipated student or the 
student eighteen years of age or older for receipt by the student of the required inoculation 
or the first or the next required of a series of inoculations within thirty days. 

(2) (Deleted by amendment, L. 94, p. 695, §2, effective April 19, 1994.) 

(3) (a) Each college and university in Colorado may work to create a tuberculosis 
screening process with the goal of making the process as uniform as possible for all colleges 
and universities in the state. The department of public health and environment may attend 
and participate in any meetings held by the universities and colleges regarding the screening 



25-4-903 Health Title 25 - page 222 

process. The screening process may include a tuberculosis risk questionnaire, a tuberculosis 
education policy, a clinical review process for each completed questionnaire, and follow-up 
testing procedures for students who are determined to be at risk for tuberculosis. On or 
before January 1, 2009, the colleges and universities that work to create a tuberculosis 
screening process pursuant to this subsection (3) shall report to the health and human 
services committees of the senate and the house of representatives, or their successor 
committees, regarding any legislative recommendations necessary regarding a tuberculosis 
screening process. 

(b) This subsection (3) shall not apply to a university or college that provides course 
work solely online. 

Source: L. 91: Entire section added, p. 931, § 2, effective April 16. L. 94: Entire 
section amended, p. 695, § 2, effective April 19; (1) amended, p. 2766, § 449, effective 
July 1. L. 2008: (3) added, p. 982, § 1, effective July 1; (1) amended, p. 132, § 16, 
effective January 1, 2009. L. 2010: (1) amended, (HB 10-1422), ch. 419, p. 2094, § 97, 
effective August 1 1 . 

Editor's note: Amendments to this section by Senate Bill 94-045 and House Bill 94-1029 were 
harmonized. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-903. Exemptions from immunization. 

(1) (Deleted by amendment, L. 97, p. 409, § 2, effective July 1, 1997.) 

(2) It is the responsibility of the parent or legal guardian to have his or her child 
immunized unless the child is exempted pursuant to this section. A student shall be 
exempted from receiving the required immunizations in the following manner: 

(a) By submitting to the student's school certification from a licensed physician or 
advanced practice nurse that the physical condition of the student is such that one or more 
specified immunizations would endanger his or her life or health or is medically contrain- 
dicated due to other medical conditions; or 

(b) By submitting to the student's school a statement of exemption signed by one parent 
or guardian or the emancipated student or student eighteen years of age or older that the 
parent, guardian, or student is an adherent to a religious belief whose teachings are opposed 
to immunizations or that the parent or guardian or the emancipated student or student 
eighteen years of age or older has a personal belief that is opposed to immunizations. 

(3) The state board of health may provide, by regulation, for further exemptions to 
immunization based upon sound medical practice. 

(4) All information distributed to parents by school districts regarding immunization 
shall inform them of their rights under subsection (2) of this section. 

Source: L. 78: Entire part R&RE, p. 428, § 1, effective April 4. L. 91: (1) and (2) 
amended, p. 932, § 3, effective April 16. L. 93: (1) amended, p. 380, § 3, effective April 
12. L. 97: Entire section amended, p. 409, § 2, effective July 1. L. 2008: (2)(a) amended, 
p. 132, § 17, effective January 1, 2009. 

Editor's note: This section is similar to former § 25-4-903 as it existed prior to 1978. 

25-4-904. Rules and regulations - immunization rules - rule-making authority of 
state board of health. ( 1 ) The state board of health shall establish rules and regulations 
for administering this part 9. Such rules and regulations shall establish which immuniza- 
tions shall be required and the manner and frequency of their administration and shall 
conform to recognized standard medical practices. Such rules and regulations may also 
require the reporting of statistical information and names of noncompliers by the schools. 
The department of public health and environment shall administer and enforce the immu- 
nization requirements. 



Title 25 - page 223 Disease Control 25-4-906 

(2) All rule-making authority granted to the state board of health under the provisions 
of this article is granted on the condition that the general assembly reserves the power to 
delete or rescind any rule of the board. All rules promulgated pursuant to this subsection (2) 
shall be subject to sections 24-4-103 (8) (c) and (8) (d) and 24-4-108, C.R.S. 

Source: L. 78: Entire part R&RE, p. 428, § 1 , effective April 4. L. 80: (2) amended, p. 
788, § 23, effective June 5. L. 94: (1) amended, p. 2767, § 450, effective July 1. 

Editor's note: This section is similar to former § 25-4-905 as it existed prior to 1978. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-905. Immunization of indigent children. (1) The county, district, or municipal 
public health agency, a public health or school nurse under the supervision of a licensed 
physician, or the department of public health and environment in the absence of a county, 
district, or municipal public health agency or public health nurse shall provide, at public 
expense to the extent that funds are available, immunizations required by this part 9 to each 
child whose parents or guardians cannot afford to have the child immunized or, if 
emancipated, who cannot himself or herself afford immunization and who has not been 
exempted. The department of public health and environment shall provide all vaccines 
necessary to comply with this section as far as funds will permit. Nothing in this section 
shall preclude the department of public health and environment from distributing vaccines 
to physicians, advanced practice nurses, or others as required by law or the rules of the 
department. No indigent child shall be excluded, suspended, or expelled from school unless 
the immunizations have been available and readily accessible to the child at public expense. 

(2) Notwithstanding any other provision of this part 9 to the contrary, programs and 
services that provide immunizations to children for communicable diseases shall be 
available to a child regardless of his or her race, religion, gender, ethnicity, national origin, 
or immigration status. 

Source: L. 78: Entire part R&RE, p. 428, § 1, effective April 4. L. 94: Entire section 
amended, p. 2767, § 451, effective July 1. L. 2006, 1st Ex. Sess.: Entire section amended, 
p. 26, § 5, effective July 31. L. 2008: (1) amended, p. 133, § 18, effective January 1, 2009. 
L. 2010: (1) amended, (HB 10-1422), ch. 419, p. 2094, § 98, effective August 11. 

Editor's note: This section is similar to former § 25-4-906 as it existed prior to 1978. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 

Law reviews. For article, "2006 Immigration 
Legislation in Colorado", see 35 Colo. Law. 79 
(October 2006). 

25-4-906. Certificate of immunization - forms. ( 1 ) The department of public health 
and environment shall provide official certificates of immunization to the schools, private 
physicians, and county, district, and municipal public health agencies. Upon the commence- 
ment of the gathering of epidemiological information pursuant to section 25-4-2403 to 
implement the immunization tracking system, such form shall include a notice that informs 
a parent or legal guardian that he or she has the option to exclude his or her infant's, child's, 
or student's immunization information from the immunization tracking system created in 
section 25-4-2403. Any immunization record provided by a licensed physician, registered 
nurse, or public health official may be accepted by the school official as certification of 
immunization if the information is transferred to the official certificate of immunization and 
verified by the school official. 



25-4-907 Health Title 25 - page 224 

(2) Each school shall maintain on file an official certificate of immunization for every 
student enrolled. The certificate shall be returned to the parent or guardian or the emanci- 
pated student or student eighteen years of age or older when a student withdraws, transfers, 
is promoted, or otherwise leaves the school, or the school shall transfer the certificate with 
the student's school record to the new school. Upon a college or university student's 
request, the official certificate of immunization shall be forwarded as specified by the 
student. 

(3) The department of public health and environment may examine, audit, and verify 
the records of immunizations maintained by each school. 

(4) All students enrolled in any school in Colorado on and after August 15, 1979, shall 
furnish the required certificate of immunization or shall be suspended or expelled from 
school. Students enrolling in school in Colorado for the first time on and after July 1, 1978, 
shall provide a certificate of immunization or shall be excluded from school except as 
provided in section 25-4-903. 

Source: L. 78: Entire part R&RE, p. 429, § 1, effective April 4. L. 91: (2) and (4) 
amended, p. 932, § 4, effective April 16. L. 92: (2) amended, p. 1273, § 2, effective April 
9. L. 94: (1) and (3) amended, p. 2767, § 452, effective July 1. L. 98: (1) amended, p. 19, 
§ 2, effective August 5. L. 2001: (1) amended, p. 825, § 3, effective August 8. L. 2007: 
(1) amended, p. 665, § 8, effective April 26. L. 2010: (1) amended, (HB 10-1422), ch. 419, 
p. 2095, § 99, effective August 11. 

Editor's note: This section is similar to former § 25-4-907 as it existed prior to 1978. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(1) and (3), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-907. Noncompliance. ( 1 ) A school official of each school shall suspend or expel 
from school, pursuant to the provisions of section 22-33-105, C.R.S., or the provisions 
established by the school official of a college or university or private school, any student not 
otherwise exempted under this part 9 who fails to comply with the provisions of this part 
9. No student shall be suspended or expelled for failure to comply with the provisions of 
this part 9 unless there has been a direct personal notification by the appropriate school 
authority to the student's parent or guardian or to the emancipated student or the student 
eighteen years of age or older of the noncompliance with this part 9 and of such person's 
rights under sections 25-4-902, 25-4-902.5, and 25-4-903. 

(2) In the event of suspension or expulsion of a student, school officials shall notify the 
state department of public health and environment or the county, district, and municipal 
public health agency. An agent of said department shall then contact the parent or guardian 
or the emancipated student or student eighteen years of age or older in an effort to secure 
compliance with this part 9 in order that the student may be reenrolled in school. 

(3) Any student expelled for failure to comply with the provisions of this part 9 shall 
not be included in calculating the dropout rate for the school from which such student was 
expelled or the school district in which such student was enrolled prior to being expelled. 
Such student shall be included in the annual report of the number of expelled students 
prepared pursuant to section 22-33-105, C.R.S. 

Source: L. 78: Entire part R&RE, p. 429, § 1, effective April 4. L. 91: Entire section 
amended, p. 933, § 5, effective April 16. L. 94: (2) amended, p. 2768, § 453, effective July 
1. L. 97: Entire section amended, p. 410, § 3, effective July L L. 2010: (2) amended, (HB 
10-1422), ch. 419, p. 2095, § 100, effective August 11. 

Cross references: For the legislative declarafion contained in the 1994 act amending subsecdon 
(2), see secfion 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-908. When exemption from immunization not recognized. If at any time there 
is, in the opinion of the state department of public health and environment or the county, 



Title 25 - page 225 Disease Control 25-4-1001 

district, or municipal public health agency, danger of an epidemic from any of the 
communicable diseases for which an immunization is required pursuant to the rules and 
regulations promulgated pursuant to section 25-4-904, no exemption or exception from 
immunization against such disease shall be recognized. Quarantine by the state department 
of public health and environment or the county, district, or municipal public health agency 
is hereby authorized as a legal alternative to immunization. 

Source: L. 78: Entire part R&RE, p. 429, § 1, effective April 4. L. 94: Entire section 
amended, p. 2768, § 454, effective July 1. L. 2010: Entire section amended, (HB 10- 
1422), ch. 419, p. 2095, § 101, effective August 11. 

Editor's note: This section is similar to former § 25-4-904 as it existed prior to 1978. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-909. Vaccine-related injury or death - limitations on liability. ( 1 ) The general 
assembly finds, determines, and declares that immunization of the population of this state 
is vital to the health of Colorado citizens and has demonstrated such finding by requiring 
such immunization pursuant to the provisions of sections 25-4-901 to 25-4-908. 

(2) No person who administers a vaccine which is required under the provisions of this 
part 9 to an infant or child whose age is greater than twenty days shall be held liable for 
injuries sustained pursuant to such vaccine if: 

(a) The vaccine was administered using generally accepted clinical methods; 

(b) The vaccine was administered according to the schedule of immunization as 
published by the communicable disease control administration of the federal government; 
and 

(c) There were no clinical symptoms nor clinical history present under which prudent 
health care professionals would not have administered such vaccine. 

(3) An action shall not be maintained for a vaccine-related injury or death until action 
for compensation for such alleged injury has been exhausted under the terms of the 
"National Childhood Vaccine Injury Act of 1986", 42 U.S.C. sees. 300aa-10 to 300aa-33, 
as such law is from time to time amended. 

(4) If the injury or death which is sustained does not fall within the parameters of the 
vaccine injury table as defined in 42 U.S.C. sec. 300aa-14, as enacted on November 14, 
1986, a rebuttable presumption is established that the injury sustained or the death was not 
due to the administration of vaccine. Such presumption shall be overcome by a prepon- 
derance of the evidence. 

Source: L. 88: Entire section added, p. 624, § 3, effective July 1. 

ANNOTATION 

Law reviews. For article, "1988 Update on 
Colorado Tort Reform Legislafion — Part I", 
see 17 Colo. Law. 1790 (1988). 

PART 10 

NEWBORN SCREENING AND GENETIC 
COUNSELING AND EDUCATION ACT 

25-4-1001. Short title. This part 10 shall be known and may be cited as the "Newborn 
Screening and Genetic Counseling and Education Act". 

Source: L. 81: Entire part added, p. 1300, § 1, effective July 1. 



25-4- 1 002 Health Title 25 - page 226 

25-4-1002. Legislative declaration. (1) The general assembly hereby finds and 
declares that: 

(a) State policy regarding newborn screening and genetic counseling and education 
should be made with full public knowledge, in light of expert opinion, and should be 
constantly reviewed to consider changing medical knowledge and ensure full public 
protection; 

(b) Participation of persons in genetic counseling programs in this state should be 
wholly voluntary and that all information obtained from persons involved in such programs 
or in newborn screening programs in the state should be held strictly confidential. 

Source: L. 81: Entire part added, p. 1300, § 1, effective July 1. 

25-4-1003. Powers and duties of executive director - newborn screening programs 
- genetic counseling and education programs - rules. (1) The executive director of the 
department of pubhc health and environment shall have the authority to: 

(a) Establish and administer state programs for newborn screening and genetic coun- 
seling and education; 

(b) Promulgate rules, regulations, and standards for the provision of newborn screening 
programs and genetic counseling and education programs; 

(c) Designate such personnel as are necessary to carry out the provisions of this part 10, 
disburse and collect such funds as are available to the administration of this part 10, and fix 
reasonable fees to be charged for services pursuant to this part 10; 

(d) Gather and disseminate information to further the public's understanding of new- 
born screening and genetic counseling and education programs; 

(e) Establish systems for recording information obtained in newborn screening and 
genetic counseling and education programs. 

(2) The executive director of the department of public health and environment shall 
comply with the following provisions: 

(a) Newborn screening shall be provided in the most efficient and cost-effective manner 
possible and newborn screening and diagnostic services should be carried out under 
adequate standards of supervision and quality control; 

(b) No program for genetic counseling shall require mandatory participation, restriction 
of childbearing, or be a prerequisite to eligibility for, or receipt of, any other service or 
assistance from, or to participation in, any other program; 

(c) Genetic counseling services shall be available to persons in need, such counseUng 
shall be nondirective, and such counseling shall emphasize informing the client and not 
require restriction of childbearing; 

(d) The extremely personal decision to bear children shall remain the free choice and 
responsibility of the individual, and such free choice and responsibility shall not be 
restricted by any of the genetic services of the state; 

(e) All information gathered by the department of public health and environment, or by 
other agencies, entities, and individuals conducting programs and projects on newborn 
screening and genetic counseling and education, other than statistical information and 
information which the individual allows to be released through his informed consent, shall 
be confidential. Public and private access to individual patient data shall be limited to data 
compiled without the individual's name. 

(f) Information on the operation of all programs on newborn screening and genetic 
counseling and education within the state, except for confidential information obtained from 
participants in such programs, shall be open and freely available to the public; 

(g) All participants in programs on genetic counseling and education shall be informed 
of the nature of possible risks involved in participation in such a program or project, and 
shall be informed of the nature and cost of available therapies or maintenance programs for 
those affected by hereditary disorders, and shall be informed of the possible benefits and 
risks of such therapies and programs; 

(h) Nothing in this section shall be construed to require any hospital or other health 
facility or any physician or other health professional to provide genetic counseling beyond 
the usual and customary and accepted practice nor shall any hospital or other health facility 
be held liable for not providing such genetic counseling. 



Title 25 - page 227 Disease Control 25-4- 1 004.5 

Source: L. 81: Entire part added, p. 1300, § 1, effective July 1. L. 94: IP(1), IP(2), and 
(2)(e) amended, p. 2768, § 455, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending the intro- 
ductory portions to subsections (1) and (2) and subsection (2)(e), see section 1 of chapter 345, Session 
Laws of Colorado 1994. 

25-4-1004. Newborn screening. 

(1) (a) Repealed. 

(b) On or after April 1, 1989, all infants born in the state of Colorado shall be tested for 
the following conditions: Phenylketonuria, hypothyroidism, abnormal hemoglobins, 
galactosemia, cystic fibrosis, biotinidase deficiency, and such other conditions as the board 
of health may determine meet the criteria set forth in paragraph (c) of this subsection (1). 
Appropriate specimens for such testing shall be forwarded by the hospital in which the child 
is bom to the laboratory operated or designated by the department of public health and 
environment for such purposes. The physician, nurse, midwife, or other health professional 
attending a birth outside a hospital shall be responsible for the collection and forwarding of 
such specimens. The results of the testing shall be forwarded directly to the physician or 
other primary health care provider for the provision of such information to the parent or 
parents of the child. The results of any testing or follow-up testing pursuant to section 
25-4-1004.5 may be sent to the immunization tracking system authorized by section 
25-4-2403 and accessed by the physician or other primary health care provider. The state 
board of health may discontinue testing for any condition listed in this paragraph (b) if, 
upon consideration of criteria set forth in paragraph (c) of this subsection (1), the board 
finds that the public health is better served by not testing infants for that condition. 

(c) The board of health shall use the following criteria to determine whether or not to 
test infants for conditions which are not specifically enumerated in this subsection (1): 

(1) The condition for which the test is designed presents a significant danger to the 
health of the infant or his family and is amenable to treatment; 

(II) The incidence of the condition is sufficiently high to warrant screening; 

(III) The test meets commonly accepted clinical standards of reliability, as demon- 
strated through research or use in another state or jurisdiction; and 

(IV) The cost-benefit consequences of screening are acceptable within the context of 
the total newborn screening program. 

(2) The executive director of the department of public health and environment shall 
assess a fee which is sufficient to cover the costs of such testing and to accomplish the other 
purposes of this part 10. Hospitals shall assess a reasonable fee to be charged the parent or 
parents of the infant to cover the costs of handling the specimens, the reimbursement of 
laboratory costs, and the costs of providing other services necessary to implement the 
purposes of this part 10. 

Source: L. 81: Entire part added, p. 1302, § 1, effective July 1. L. 83: (2) amended, p.' 
1070, § 1, effective May 20. L. 87: (1) amended, p. 1128, § 1, effective July 1. L. 88: (1) 
amended, p. 1009, § 1, effective July 1. L. 91: (1) amended, p. 949, § 17, effective May 
6. L. 94: (l)(b) and (2) amended, p. 2769, § 456, effective July 1. L. 96: (l)(b) amended, 
p. 1107, § 1, effective July 1. L. 2007: (l)(b) amended, p. 654, § 2, effective April 26. 

Editor's note: Subsection (l)(a)(II) provided for the repeal of subsection (l)(a), effective April 1, 
1989. (See L. 88, p. 1009.) 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(l)(b) and (2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-1004.5. Follow-up testing and treatment - second screening - legislative 
declaration - fee - rules. (1) The general assembly finds that: 

(a) Newborn screening authorized by section 25-4-1004 is provided for every newborn 
in the state; 



25-4-1004.5 Health Title 25 - page 228 

(b) Newborn testing is designed to identify metabolic disorders that cause mental 
retardation and other health problems unless they are diagnosed and treated early in life; 

(c) In order to ensure that children with metabolic disorders are able to lead as normal 
a life as possible and to minimize long-term health care costs for such children, it is 
necessary to provide centralized follow-up testing and treatment services; 

(d) For over twenty-five years the follow-up testing and treatment services were 
provided by a federal grant that was discontinued June 30, 1993. Since that time, follow-up 
testing and treatment services have been limited. If alternative sources of funding are not 
provided, those services will be eliminated. 

(e) A nominal increase of the fee on newborn screening to cover the costs of providing 
follow-up and referral services would allow for those services to be continued; 

(f) Over the past ten years, many children with serious health conditions have received 
timely diagnosis and treatment as a result of the newborn screening required by this part 10. 
Such screening has averted the possibility of life-long institutionalization of some children 
and substantial related health care costs. The general assembly further finds, however, that 
many infants who are screened early in life may exhibit false or inaccurate results on certain 
newborn screening tests. The general assembly therefore finds and declares that subsequent 
newborn screening will provide more accurate and reliable test results for the timely and 
effective diagnosis and treatment of certain health conditions in newborn infants and the 
best interests of children in Colorado will be served by a new screening program that 
routinely tests all newborns twice. 

(2) (a) Repealed. 

(b) On and after July 1 , 1994, the executive director of the department of public health 
and environment shall increase the newborn screening fee as provided in section 25-4-1004 
(2) so that the fee is sufficient to include the costs of providing follow-up and referral 
services to families with a newborn whose test results under a newborn screening indicate 
a metabolic disorder. Follow-up services include comprehensive diagnostic testing. The 
increase shall not exceed five dollars; except that it may be adjusted annually to reflect any 
change in the Denver-Boulder consumer price index. Any fees collected shall be subject to 
the provisions of section 25-4-1006. 

(3) (a) On and after July 1, 1996, all infants bom in the state of Colorado who receive 
newborn screening pursuant to section 25-4-1004 (1) shall have a second specimen taken 
to screen for the following conditions: 

(I) Phenylketonuria; 

(II) Hypothyroidism; 

(III) Galactosemia; 

(IV) Cystic fibrosis; and 

(V) Such other conditions as the state board of health may determine meet the criteria 
set forth in section 25-4-1004 (1) (c) and require a second screening for accurate test results. 

(b) The executive director of the department of public health and environment is 
authorized to promulgate rules, regulations, and standards for the implementation of the 
second specimen testing specified in this subsection (3), including but not limited to the 
following: 

(I) Identification of those conditions for which a second specimen shall be required; 

(II) The age of the infant at which the second screening may be administered; 

(III) The method by which the parent or parents of a newborn shall be advised of the 
necessity for a second specimen test; 

(IV) The procedure to be followed in administering the second specimen test; 

(V) Any exceptions to the necessity for a second specimen test and the procedures to 
be followed in such cases; and 

(VI) The standards of supervision and quality control that shall apply to second 
specimen testing. 

(c) On and after July 1, 1996, the executive director of the department of public health 
and environment may adjust the newborn screening fee set forth in section 25-4-1004 (2) 
so that the fee is sufficient to cover the costs associated with the second screening described 
in this subsection (3). Any increase shall be in addition to the fee described in subsection 
(2) of this section and shall not initially exceed five dollars and seventy-five cents but may 



Title 25 - page 229 Disease Control 25-4- 1 004.7 

be adjusted annually to reflect any actual cost increase associated with the administration of 
the second screening. Any fees collected pursuant to this paragraph (c) shall be subject to 
the provisions of section 25-4-1006. 

(4) The provisions of section 25-4-1003 (2) shall apply to second newborn screenings. 

Source: L. 94: Entire section added, p. 833, § 1, effective April 28. L. 96: (l)(f), (3), 
and (4) added, p. 1108, §§ 2, 3, effective July 1. 

Editor's note: Subsection (2)(a)(II) provided for the repeal of subsection (2)(a), effective July 1 , 
1994. (See L. 94, p. 833.) 

25-4-1004.7. Newborn hearing screening - legislative declaration - advisory com- 
mittee - report - rules - repeal. (1) (a) The general assembly finds, determines, and 
declares: 

(1) That hearing loss occurs in newborn infants more frequently than any other health 
condition for which newborn infant screening is required; 

(II) That eighty percent of the language ability of a child is established by the time the 
child is eighteen months of age and that hearing is vitally important to the healthy 
development of such language skills; 

(III) That early detection of hearing loss in a child and early intervention and treatment 
has been demonstrated to be highly effective in facilitating a child's healthy development 
in a manner consistent with the child's age and cognitive ability; 

(IV) That children with hearing loss who do not receive such early intervention and 
treatment frequently require special educational services and that such services are publicly 
funded for the vast majority of children with hearing needs in the state; 

(V) That appropriate testing and identification of newborn infants with hearing loss will 
facilitate early intervention and treatment and may therefore serve the public purposes of 
promoting the healthy development of children and reducing public expenditure; and 

(VI) That consumers should be entitled to know whether the hospital at which they 
choose to deliver their infant provides newborn hearing screening. 

(b) For these reasons the general assembly hereby determines that it would be bene- 
ficial and in the best interests of the development of the children of the state of Colorado 
that newborn infants' hearing be screened. 

(2) (a) (I) There is hereby established an advisory committee on hearing in newborn 
infants for the purpose of collecting the informational data specified in paragraph (b) of 
subsection (3) of this section, and for the purpose of providing recommendations to 
hospitals, other health care institutions, the department of public health and environment, 
and the public concerning, but not necessarily limited to, the following: 

(A) Appropriate methodologies to be implemented for hearing screening of newborn 
infants, which methodologies shall be objective and physiologically based and which shall 
not include a requirement that the initial newborn hearing screening be performed by an 
audiologist; 

(B) The number of births sufficient to qualify a hospital or health institution to arrange 
otherwise for hearing screenings; and 

(C) Guidelines for reporting and the means to assure that identified children receive 
referral for appropriate follow-up services. 

(II) The advisory committee on hearing in newborn infants shall consist of at least 
seven members who shall be appointed by the executive director of the department of public 
health and environment. Members appointed to the committee shall have training, experi- 
ence, or interest in the area of hearing conditions in children. 

(III) The members of the advisory committee on hearing in newborn infants shall serve 
without compensation. 

(IV) Repealed. 

(b) This subsection (2) is repealed, effective July 1, 2013. Prior to such repeal, the 
advisory committee on hearing in newborn infants shall be reviewed as provided for in 
section 2-3-1203, C.R.S. 



25-4- 1 005 Health Title 25 - page 230 

(3) (a) It is the intent of the general assembly that newborn hearing screening be 
conducted on no fewer than ninety-five percent of the infants bom in hospitals, using 
procedures recommended by the advisory committee on hearing in newborn infants, created 
in subsection (2) of this section. Toward that end, every licensed or certified hospital shall 
educate the parents of infants born in such hospitals of the importance of screening the 
hearing of newborn infants and follow-up care. Education shall not be considered a 
substitute for the hearing screening described in this section. Every licensed or certified 
hospital shall report annually to the advisory committee concerning the following: 

(I) The number of infants born in the hospital; 

(II) The number of infants screened; 

(III) The number of infants who passed the screening, if administered; and 

(IV) The number of infants who did not pass the screening, if administered. 

(b) The advisory committee on hearing in newborn infants shall determine which 
hospitals or other health care institutions in the state of Colorado are administering hearing 
screening to newborn infants on a voluntary basis and the number of infants screened. 

(I) to (IV) Repealed. 

(c) Repealed. 

(4) (a) If the number of infants screened falls below eighty-five percent, the board of 
health shall promulgate rules requiring hearing screening of newborn infants pursuant to 
section 24-4-103, C.R.S., of the "State Administrative Procedure Act". 

(b) Such rules, if promulgated, shall address those hospitals with a low volume of 
births, as determined by the state board of health based upon recommendations by the 
advisory committee on hearing in newborn infants, which may arrange otherwise for 
newborn infant hearing screening. 

(5) A physician, nurse, midwife, or other health professional attending a birth outside 
a hospital or institution shall provide information, as established by the department, to 
parents regarding places where the parents may have their infants' hearing screened and the 
importance of such screening. 

(6) The department shall encourage the cooperation of county, district, and municipal 
public health agencies, health care clinics, school districts, and any other appropriate 
resources to promote the screening of newborn infants' hearing for those infants bom 
outside a hospital or institution. 

Source: L. 97: Entire section added, p. 1118, § 1, effective July 1. L. 2005: (2)(a)(I), 
(2)(b), (3)(a), IP(3)(b), and (4)(a) amended and (2)(a)(IV), (3)(b)(I) to (3)(b)(IV), and (3)(c) 
repealed, p. 252, §§ 3, 4, 5, effective July 1. L. 2008: (2)(b) amended, p. 1906, § 100, 
effective August 5. L. 2010: (6) amended, (HB 10-1422), ch. 419, p. 2096, § 102, effective 
August 11. 

25-4-1005. Exceptions. Nothing in the provisions of this part 10 shall be construed to 
require the testing or medical treatment for the minor child of any person or of any person 
who is a member of a well-recognized church or religious denomination and whose 
religious convictions in accordance with the tenets or principles of his church or religious 
denomination are against medical treatment for disease or physical defects or has a personal 
objection to the administration of such tests or treatment. 

Source: L. 81: Entire part added, p. 1302, § 1, effective July 1. 

25-4-1006. Cash funds. (1) All moneys received from fees collected pursuant to this 
part 10 shall be transmitted to the state treasurer who shall credit the same to the newborn 
screening and genetic counseling cash funds, which funds are hereby created. Such moneys 
shall be utilized for expenditures authorized or contemplated by and not inconsistent with 
the provisions of this part 10 relating to newborn screening, follow-up care, and genetic 
counseling and education programs and functions. All moneys credited to the newbom 
screening and genetic counseling cash funds shall be used as provided in this part 10 and 
shall not be deposited in or transferred to the general fund of this state or any other fund. 



Title 25 - page 23 1 Disease Control 25-4- 1 202 

(2) Notwithstanding any provision of this section to the contrary, for the fiscal year 
beginning July 1, 1988, the state treasurer shall transfer to the general fund out of any 
unappropriated moneys in the newborn screening and genetic counseling cash funds the 
sum of five hundred thousand dollars. 

Source: L. 81: Entire part added, p. 1302, § 1, effective July 1. L. 88: Entire section 
amended, p. 1011, § 1, effective May 23. L. 94: Entire section amended, p. 834, § 2, 
effective April 28. 

PART 11 

KENNELS 

25-4-1101 to 25-4-1111. (Repealed) 

Source: L. 94: Entire part repealed, p. 1313, § 17, effective July 1. 

Editor's note: (1) This part 11 was added in 1983. For amendments to this part 11 prior to its 
repeal in 1994, consult the Colorado statutory research explanatory note and the table itemizing the 
replacement volumes and supplements to the original volume of C.R.S. 1973 beginning on page vii 
in the front of this volume. 

(2) Prior to the enactment of this part 1 1 in 1983, substantive provisions concerning pet shops and 
boarding kennels were found in article 57 of title 12. 

PART 12 
STREPTOCOCCUS CONTROL 

25-4-1201. Powers and duties of executive director. (1) The executive director of 
the department of public health and environment shall have the authority to: 

(a) Establish and administer a culture-testing program to test for streptococcus; 

(b) Designate such personnel as are necessary to carry out the provisions of this part 12, 
disburse and collect such funds as are available for the administration of this part 12, and 
fix reasonable fees to be charged for services pursuant to this part 12. 

Source: L. 84: Entire part added, p. 766, § 1, effective April 5. L. 94: IP(1) amended, 

p. 2769, § 458, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending the intro- 
ductory portion to subsection (1), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-1202. Streptococcus cash fund. ( 1 ) The executive director of the department of 
public health and environment shall establish the fees to be collected for any streptococcus 
culture test performed by the department. 

(2) (a) All moneys collected pursuant to this part 12 shall be transmitted to the state 
treasurer, who shall credit the same to the streptococcus cash fund, which fund is hereby 
created. All moneys credited to the streptococcus cash fund shall be subject to appropriation 
by the general assembly to be used as provided in this section and shall not be deposited in 
or transferred to the general fund of this state or to any other fund. 

(b) Notwithstanding any provision of paragraph (a) of this subsection (2) to the 
contrary, on April 20, 2009, the state treasurer shall transfer the balance of moneys in the 
streptococcus cash fund to the general fund. 

(3) (a) The executive director of the department of public health and environment shall 
propose, as part of the annual budget request of the department of public health and 
environment, an adjustment in the amount of the fee for the streptococcus culture test which 
the department is authorized by law to collect. The budget request and the adjusted fees for 
the streptococcus culture test shall reflect direct and indirect costs. 



25-4- 1 30 1 Health Title 25 - page 232 

(b) Based upon the appropriation made by the general assembly, the executive director 
of the department of public health and environment shall adjust the streptococcus fee so that 
the revenue generated from said fee approximates the department's direct and indirect costs. 
Such fee shall remain in effect for the fiscal year for which the budget request applies. 

(c) Beginning July 1, 1984, and each July 1 thereafter, whenever moneys appropriated 
to the department of public health and environment for its activities pursuant to this part 12 
for the prior fiscal year are unexpended, said moneys shall be made a part of the 
appropriation to the department for the next fiscal year, and such amount shall not be raised 
from fees collected by such department. If a supplemental appropriation is made to the 
department for such activities, the streptococcus fee of the department, when adjusted for 
the fiscal year next following the year in which the supplemental appropriation was made, 
shall be adjusted by an additional amount which is sufficient to compensate for such 
supplemental appropriation. Moneys to be appropriated annually to the department in the 
general appropriation bill for the purposes of this part 12 shall be designated as cash funds 
and shall not exceed the amount anticipated to be raised from such fee collected by the 
department. 

Source: L. 84: Entire part added, p. 766, § 1, effective April 5. L. 94: (1) and (3) 
amended, p. 2770, § 459, effective July 1. L. 2009: (2) amended, (SB 09-208), ch. 149, p. 
624, § 22, effective April 20. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 

(1) and (3), see section 1 of chapter 345, Session Laws of Colorado 1994. 

PART 13 
RETAIL FOOD STORE SANITATION ACT 

25-4-1301. Legislative declaration. The general assembly hereby declares that the 
sanitary protection of bulk foods and the sanitary maintenance of equipment used to display 
and dispense bulk foods are matters of statewide concern and are affected with a public 
interest and that the provisions of this part 13 are enacted in the exercise of the police 
powers of this state for the purpose of protecting the health, peace, safety, and general 
welfare of the people of this state. 

Source: L. 85: Entire part added, p. 883, § 1, effective July 1. 

25-4-1302. Definitions. As used in this part 13, unless the context otherwise requires: 

(1) "Bulk foods" means unpackaged or unwrapped foods, either processed or unpro- 
cessed, in aggregate containers from which quantities desired by the consumer are with- 
drawn. "Bulk foods" does not include fresh fruits, fresh vegetables, nuts in the shell, salad 
bars, bulk pet foods, potentially hazardous foods, and bulk nonfood items. 

(2) "Department" means the department of public health and environment. 

(3) "Display area" means a location, including physical facilities and equipment, 
where bulk foods are offered for customer self-service. 

(4) "Potentially hazardous foods" includes any food that consists in whole or in part of 
milk or milk products, eggs, meat, poultry, fish, shellfish, edible Crustacea, or other food 
products or ingredients, including synthetic ingredients, in a form capable of supporting 
rapid and progressive growth of infectious or toxigenic microorganisms. This term does not 
include refrigerated, clean, whole, uncracked, odor-free shell eggs. 

(5) "Product module" means a food-contact container (multiuse or single-service) 
designed for customer self-service of bulk foods by either direct or indirect means. 

(6) "Servicing area" means a designated location equipped for cleaning, sanitizing, 
drying, or refilling product modules or for preparing bulk foods. 

Source: L. 85: Entire part added, p. 883, § 1, effective July 1. L. 89: (4) amended, p. 
1154, § 1, effective April 21. L. 94: (2) amended, p. 2770, § 460, effective July 1. 



Title 25 - page 233 Disease Control 25-4- 1 306 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-1303. Labeling - product modules - take-home containers. (1) Product mod- 
ules shall be labeled with either: 

(a) The manufacturer's or processor's bulk food container labeling plainly in view; or 

(b) A counter card, a counter sign, or any other appropriate device bearing prominently 
and conspicuously the common name of the product, a list of ingredients in their proper 
order of predominance, and a declaration of artificial color or flavor and chemical 
preservatives if contained in the product. 

(2) Any unpackaged bulk food need not comply with the labeling requirements of this 
section if the unpackaged bulk food is manufactured on the premises of a store or 
manufactured by the same store at a different location and if the manufactured bulk food is 
offered for retail sale on the store's premises and if there are no state requirements. 

(3) Labels or marking pens shall be available to customers to identify their take-home 
containers with the common name of the product unless the product is readily identifiable 
on sight. 

Source: L. 85: Entire part added, p. 884, § 1, effective July 1. 

25-4-1304. Bulk food protection. (1) Bulk foods and product modules shall be 
protected from contamination during display, customer self-service, refilling, and storage. 

(2) Containers of bulk pet foods and bulk nonfood items shall be separated from 
product modules by a barrier or open space. 

(3) Bulk foods returned to stores by customers shall not be offered for resale. 

(4) Only containers provided by stores in their display areas shall be filled with bulk 
foods; except that any customer may fill or refill his own container with vended or 
dispensed water; however, the risk that the customer's own container is unsafe, unpure, 
contaminated, or in a nonsterile condition when it is filled or refilled by the customer, shall 
be borne solely by the customer, and, except for warranties, no liability shall attach thereto 
to the manufacturer, seller, or dispenser of such container. 

Source: L. 85: Entire part added, p. 884, § 1, effective July 1. L. 89: (4) amended, p. 
1154, § 2, effective April 21. 

25-4-1305. Bulk food display. (1) Bulk foods shall be dispensed only from product 
modules which are protected by close-fitting, individual covers. If any product module is to 
be opened by customers, the cover shall be self-closing and shall remain closed when not 
in use. 

(2) Customer access to bulk foods in product modules shall be limited and controlled 
to avoid the introduction of contaminants. All product modules shall have an access height 
of thirty inches or more above the floor and a depth of eighteen inches or less. 

(3) Potentially hazardous foods shall not be made available for customer self-service. 

Source: L. 85: Entire part added, p. 884, § 1, effective July 1. 

25-4-1306. Dispensing utensils. (1) Manual handling of bulk foods by customers 
during dispensing shall be discouraged. Mechanical dispensing devices shall be used, 
including gravity dispensers, pumps, extruders, and augers. Manual dispensing utensils 
shall also be used, including tongs, scoops, ladles, and spatulas. 

(2) If the dispensing devices and utensils listed in subsection (1) of this section do not 
discourage manual customer handling of bulk foods, such bulk foods must be wrapped or 
sacked prior to display. 

(3) Manual dispensing utensils shall be protected against becoming contaminated and 
serving as vehicles for introducing contamination into bulk foods. A tether of easily 
cleanable material shall be attached to such a utensil and shall be of such length that the 



25-4-1307 Health Title 25 - page 234 

utensil cannot contact the floor. A sleeve or protective housing attached or adjacent to the 
display unit shall be available for storing a utensil when not in use. 

(4) Ladles and spatulas shall be stored in bulk foods with handles extending to the 
outside of product modules. Handles shall not prevent lids from being self-closing. 

Source: L. 85: Entire part added, p. 885, § 1, effective July 1. 

25-4-1307. Materials. Product modules and utensils shall be constructed of safe 
materials and shall be corrosion resistant, nonabsorbent, smooth, easily cleanable, and 
durable under conditions of normal use. Wood shall not be used as a food-contact surface. 

Source: L. 85: Entire part added, p. 885, § 1, effective July 1. 

25-4-1308. Food-contact surfaces. Product modules, lids, dispensing units, and uten- 
sils shall be designed and fabricated to meet the requirements for food-contact surfaces, as 
provided in section 25-4-1307. 

Source: L. 85: Entire part added, p. 885, § 1, effective July 1. 

25-4-1309. Non-food-contact surfaces. Surfaces of product module display units, 
tethers, and display equipment which are not intended for food contact but which are 
exposed to splash, food debris, or other soiling shall be designed and fabricated to be 
smooth, cleanable, durable under conditions of normal use, and free of unnecessary ledges, 
projections, and crevices. The materials for non-food-contact surfaces shall be nonabsor- 
bent or made nonabsorbent by being finished and sealed with a cleanable coating. 

Source: L. 85: Entire part added, p. 885, § 1, effective July 1. 

25-4-1310. Accessibility. Individual product modules shall be designed to be easily 
removable from a display unit for servicing unless the product modules are so designed and 
fabricated that they can be effectively cleaned and sanitized when necessary through a 
manual in-place cleaning procedure that will not contaminate or otherwise adversely affect 
bulk foods or equipment in any adjoining display areas. 

Source: L. 85: Entire part added, p. 885, § 1, effective July 1. 

25-4-1311. Equipment sanitization. (1) Tongs, scoops, ladles, spatulas, and other 
appropriate utensils and tethers used by customers shall be cleaned and sanitized at least 
daily or at more frequent intervals based on the type of bulk food and the amount of food 
particle accumulation or soiling. 

(2) When soiled, product modules, lids, and other equipment shall be cleaned and 
sanitized prior to restocking or at intervals of a schedule based on the type of bulk food and 
the amount of food particle accumulation. 

(3) Food-contact surfaces shall be cleaned and sanitized immediately if contamination 
is observed or suspected. 

(4) Facilities and equipment shall be available, either in a servicing area or in place, to 
provide for the proper cleaning and sanitizing of all food-contact surfaces, including 
product modules, lids, and dispensing utensils. 

(5) Take-home containers, including but not limited to bags, cups, and lids, which are 
provided in a display area for customer use shall be stored and dispensed in a sanitary 
manner. 

Source: L. 85: Entire part added, p. 885, § 1, effective July 1. 

25-4-1312. Violation - penalty. Any retail food store owner violating any of the 
provisions of this part 13 is guilty of a misdemeanor and, upon conviction thereof, shall be 



Title 25 - page 235 Disease Control 25-4- 1 40 1 

punished by a fine of not more than five hundred dollars, or by imprisonment in the county 
jail for not more than ninety days, or by both such fine and imprisonment. It is the duty of 
the district attorneys of the several districts of this state to prosecute for violations of this 
part 13 as for other crimes and misdemeanors. 

Source: L. 85: Entire part added, p. 886, § I, effective July 1. 

25-4-1313. Rules and regulations. The department has the power to promulgate rules 
and regulations for the implementation of this part 13. 

Source: L. 85: Entire part added, p. 886, § 1, effective July 1. 

25-4-1314. Limitation. The provisions of this part 13 shall be expressly limited to 
retail food store outlets. 

Source: L. 85: Entire part added, p. 886, § 1, effective July 1. 

PART 14 
HIV INFECTION AND ACQUIRED IMMUNE DEFICIENCY SYNDROME 

Cross references: For prostitution with knowledge of being infected with AIDS, see § 1 8-7-201 .7; 
for patronizing a prostitute with knowledge of being infected with AIDS, see § 18-7-205.7. 

Law reviews: For article, "Medical and Legal Aspects of AIDS", see 15 Colo. Law. 812 (1986); 
for article, "AIDS: Malpractice and Transmission Liability", see 58 U. Colo. L. Rev. 63 (1986-87); 
for article, "The Legal Risks of AIDS: Moving Beyond Discrimination", see 18 Colo. Law. 605 
(1989); for comment, "Liability Without Fault and the AIDS Plague Compel a New Approach to 
Cases of Transfusion - Transmitted Disease", see 61 U. Colo. L. Rev. 81 (1990); for article, 
"Employees, Privacy Rights and AIDS", see 19 Colo. Law. 1839 (1990). 

25-4-1401. Legislative declaration. The general assembly hereby declares that infec- 
tion with human immunodeficiency virus, the virus which causes acquired immune defi- 
ciency syndrome (AIDS), referred to in this part 14 as "HIV", is an infectious and 
communicable disease that endangers the population of this state. The general assembly 
further declares that reporting of HIV infection to public health officials is essential to 
enable a better understanding of the disease, the scope of exposure, the impact on the 
community, and the means of control; that efforts to control the disease should include 
public education, counseling, and voluntary testing; that restrictive enforcement measures 
should be used only when necessary to protect the public health; and that having AIDS or 
the HIV infection, being presumed to have the HIV infection, or seeking testing for the 
presence of such infection should not serve as the basis for discriminatory actions or the 
prevention of access to services. The general assembly further declares that the purpose of 
this part 14 is to protect the pubhc health and prevent the spread of said disease. 

Source: L. 87: Entire part added, p. 1130, § 1, effective June 8. L. 90: Entire section 
amended, p. 1309, § 1, effective May 24. 

ANNOTATION 

Applicability of part. Nothing in the statu- on the part of the general assembly to give this 
tory scheme of this part 14 demonstrates intent part 14 retroactive effect so that it applied prior 



25-4-1402 Health Title 25 - page 236 

to June 8, 1987, the effective date of the act. was filed in February of 1987 and the first 

Belle Bonfils Memorial Blood Center v. District request for discovery of information was in 

Court, 763 P.2d 1003 (Colo. 1988). April of 1987. Belle Bonfils Memorial Blood 

Statute does not apply to discovery in negli- Center v. District Court, 763 P.2d 1003 (Colo, 

gence action by patient infected with the AIDS 1988). 
virus after a blood transfusion where lawsuit 

25-4-1402. Reports of HIV infection. (1) Every attending physician in this state 
shall make a report to the state department of public health and environment or local 
department of health, in a form and within a time period designated by the state department 
of public health and environment, on every individual known by said physician to have a 
diagnosis of AIDS, HIV-related illness, or HIV infection, including death from HIV 
infection. 

(2) All other persons treating a case of HIV infection in hospitals, clinics, sanitariums, 
penal institutions, and other private or public institutions shall make a report to the state 
department of public health and environment or local department of health, in a form and 
within a time period designated by the state department of public health and environment, 
on every individual having a diagnosis of AIDS, HIV-related illness, or HIV infection, 
including death from HIV infection. 

(3) Repealed. 

(4) The reports required to be made under the provisions of subsections ( 1 ) and (2) of 
this section shall contain the name, date of birth, sex, and address of the individual reported 
on and the name and address of the physician or other person making the report. 

(5) Good faith reporting or disclosure pursuant to this section or section 25-4-1403 
shall not constitute libel or slander or a violation of the right of privacy or privileged 
communication. 

(6) Any person who in good faith complies completely with this part 14 shall be 
immune from civil and criminal liability for any action taken in compliance with the 
provisions of this part 14. Compliance by a physician with the reporting requirements of this 
part 14 and with any regulations promulgated by the state department of public health and 
environment relating thereto shall fulfill any duty of such physician to a third party. 

Source: L. 87: Entire part added, p. 1130, § 1, effective June 8. L. 90: (1) and (2) 
amended and (3) repealed, pp. 1309, 1314, §§ 2, 10, effective May 24. L. 94: (1), (2), and 
(6) amended, p. 2770, § 461, effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending subsections 
(1), (2), and (6), see section 1 of chapter 345, Session Laws of Colorado 1994. 

ANNOTATION 

Because having AIDS or seeking testing for by the plaintiff's employer was sufficient to 

the presence of such infection should not support a claim for invasion of privacy. Borquez 

serve as a basis for discriminatory actions, v. Robert C. Ozer, PC, 923 P.2d 166 (Colo, 

information concerning the plaintiff's health and App. 1995), affd in part and rev'd in part on 

possible HIV infection was not of legitimate other grounds, 940 R2d 371 (Colo. 1997). 
public concern. Publication of such information 

25-4-1402.5. Exemption from reporting. (Repealed) 

Source: L. 91: Entire section added, p. 995, § 1, effective April 20. L. 94: (4) repealed, 
p. 696, § 3, effective April 19; (1) amended, p. 2771, § 462, effective July 1. L. 2009: 
Entire section repealed, (SB 09-179), ch. 112, p. 474, § 18, effective April 9. 

25-4-1403. Reports of positive HIV tests. All laboratories or persons performing 
laboratory tests for HIV shall report to the state department of public health and environ- 
ment or appropriate local department of health, in a form and within a time period 



Title 25 - page 237 Disease Control 25-4-1404 

designated by the state department of public health and environment, the name, date of 
birth, sex, and address of any individual whose specimen submitted for examination tests 
positive for HIV as defined by the state board of health. Such report shall include the test 
results and the name and address of the attending physician and any other person or agency 
referring such positive specimen for testing. 

Source: L. 87: Entire part added, p. 1131, § 1, effective June 8. L. 90: Entire section 
amended, p. 1310, § 3, effective May 24. L. 94: Entire section amended, p. 2771, § 463, 
effective July 1. 

Cross references: For the legislative declaration contained in the 1994 act amending this section, 
see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-1404. Use of reports. (1) The public health reports required to be submitted by 
sections 25-4-1402 and 25-4-1403 and records resulting from compliance with section 
25-4-1405 (1) and held by the state department of public health and environment, any 
county, district, and municipal public health agency, or any health care provider or facility, 
third-party payor, physician, clinic, laboratory, blood bank, or other agency shall be strictly 
confidential information. Such information shall not be released, shared with any agency or 
institution, or made public, upon subpoena, search warrant, discovery proceedings, or 
otherwise, except under any of the following circumstances: 

(a) Release may be made of such information for statistical purposes in a manner such 
that no individual person can be identified. 

(b) Release may be made of such information to the extent necessary to enforce the 
provisions of this part 14 and related rules and regulations concerning the treatment, 
control, and investigation of HIV infection by public health officials. 

(c) Release may be made of such information to medical personnel in a medical 
emergency to the extent necessary to protect the health or life of the named party. 

(d) An officer or employee of the county, district, or municipal public health agency or 
state department of public health and environment may make a report of child abuse to 
agencies responsible for receiving or investigating reports of child abuse or neglect in 
accordance with the applicable provisions of the "Child Protection Act of 1987" set forth 
in part 3 of article 3 of title 19, C.R.S. However, in the event a report is made, only the 
following information shall be included in the report: 

(1) The name, address, and sex of the child; 

(II) The name and address of the person responsible for the child; 

(III) The name and address of the person who is alleged to be responsible for the 
suspected abuse or neglect, if known; and 

(IV) The general nature of the child's injury. 

(e) The state department of public health and environment and any county, district, or 
municipal public health agency, upon being contacted by a district attorney pursuant to 
section 18-3-415.5, C.R.S. , shall provide the information specified in said section. 

(f) An officer or employee of the state department of public health and environment or 
of a county, district, or municipal public health agency, pursuant to section 18-3-415.5, 
C.R.S., shall provide, for purposes of a sentencing hearing, oral and documentary evidence 
limited to whether a person who has been bound over for trial for any sexual offense, as 
described in section 18-3-415.5, C.R.S., was provided notice that he or she had tested 
positive for the human immunodeficiency virus (HIV) that causes acquired immune 
deficiency syndrome or had discussion concerning his or her HIV infection, and the date of 
such notice or discussion. 

(2) No officer or employee of the state department of public health and environment or 
of a county, district, or municipal public health agency shall be examined in any judicial, 
executive, legislative, or other proceeding as to the existence or content of any individual's 
report retained by such department pursuant to this part 14 or as to the existence of the 
contents of reports received pursuant to sections 25-4-1402 and 25-4-1403 or the results of 
investigations in section 25-4-1405. This provision shall not apply to administrative or 



25-4-1405 Health Title 25 - page 238 

judicial proceedings pursuant to section 25-4-1406 or 25-4-1407 or section 18-3-415.5, 
C.R.S. 

(3) Information regarding AIDS and HIV infection in medical records held by a facility 
that provides ongoing health care is considered medical information, not public health 
reports, and is protected from unauthorized disclosure as provided in section 18-4-412, 
C.R.S. 

Source: L. 87: Entire part added, p. 1131, § 1, effective June 8. L. 90: (1) amended and 
(3) added, p. 1310, § 4, effective May 24. L. 93: (l)(d) added, p. 1610, § 4, effective June 
6. L. 94: IP(1), IP(l)(d), and (2) amended, p. 2772, § 464, effective July 1. L. 99: (l)(e) 
and (l)(f) added and (2) amended, pp. 1002, 1003, §§ 7, 8, effective May 29. L. 2010: 
IP(1), IP(l)(d), (l)(e), (l)(f), and (2) amended, (HB 10-1422), ch. 419, p. 2096, § 103, 
effective August 1 1 . 

Cross references: For the legislative declaration contained in the 1994 act amending the intro- 
ductory portions to subsections (1) and (l)(d) and subsection (2), see section 1 of chapter 345, Session 
Laws of Colorado 1994. For the legislative declaration contained in the 1999 act amending this 
section, see section 1 of chapter 254, Session Laws of Colorado 1999. 

ANNOTATION 

Because reports and records concerning public concern. Publication of such information 

persons who are diagnosed with AIDS, HIV- by the plaintiffs employer was sufficient to 

related illness, or HIV infection are strictly support a claim for invasion of privacy. Borquez 

confidential under this section and may be v. Robert C. Ozer, P.C, 923 P.2d 166 (Colo. 

released only under specified circumstances, App. 1995), aff d in part and rev'd in part on 

information concerning the plaintiffs health and other grounds, 940 P.2d 371 (Colo. 1997). 
possible HIV infection was not of legitimate 

25-4-1405. Disease control by the state department of public health and environ- 
ment and county, district, and municipal public health agencies. (1) It is the duty of 
the executive director or the chief medical officer of the state department of public health 
and environment and county, district, and municipal public health directors to investigate 
sources of HIV infection and to use every proper means to prevent the spread of the disease. 

(2) It is the duty of the executive director or the chief medical officer of the state 
department of public health and environment and county, district, and municipal public 
health directors, as part of disease control efforts, to provide public information, risk- 
reduction education, confidential voluntary testing and counseling, educational materials for 
use in schools, and professional education to health care providers. 

(3) The state department of public health and environment shall develop and implement 
programs under which the state department and county, district, and municipal public health 
agencies may perform the following tasks: 

(a) Prepare and disseminate to health care providers circulars of information and 
presentations describing the epidemiology, testing, diagnosis, treatment, medical, counsel- 
ing, and other aspects of HIV infection; 

(b) Provide consultation to agencies and organizations regarding appropriate policies 
for testing, education, confidentiality, and infection control; 

(c) Conduct health information programs to inform the general public of the medical 
and psychosocial aspects of HIV infection, including updated information on how infection 
is transmitted and can be prevented. The department shall prepare for free distribution 
among the residents of the state printed information and instructions concerning the dangers 
from HIV infection, its prevention, and the necessity for testing. 

(d) Prepare and update an educational program on HIV infection in the workplace for 
use by employers; 

(e) Develop and implement HIV education risk-reduction programs for specific popu- 
lations at higher risk for infection; and 

(f) Develop and update a medically correct AIDS prevention curriculum for use at the 
discretion of secondary and middle schools. 



Title 25 - page 239 Disease Control 25-4-1405 

(4) School districts are urged to provide every secondary school student, with parental 
consent, education on HIV infection and AIDS and its prevention. 

(5) It is the duty of every physician who, during the course of an examination, discovers 
the existence of HIV infection or who treats a patient for HIV infection to inform the patient 
of the interpretation of laboratory results and counsel the patient on measures for preventing 
the infection of others, prophylaxis and treatment of opportunistic infections, treatment to 
prevent progression of HIV infection, and the necessity of regular medical evaluation. 

(6) Any county, district, or municipal public health agency, state institution or facility, 
medical practitioner, or public or private hospital or clinic may examine and provide 
treatment for HIV infection for any minor if such physician or facility is qualified to provide 
such examination and treatment. The consent of the parent or guardian of such minor shall 
not be a prerequisite to such examination and treatment. The physician in charge or other 
appropriate authority of the facility or the licensed physician concerned shall prescribe an 
appropriate course of treatment for such minor. The fact of consultation, examination, and 
treatment of such a minor under the provisions of this section shall be absolutely confi- 
dential and shall not be divulged by the facility or physician to any person other than the 
minor except for purposes of a report required under sections 25-4-1402 and 25-4-1403 and 
subsection (8) of this section and a report containing the name and medical information of 
the minor made to the appropriate authorities if required by the "Child Protection Act of 
1987", part 3 of article 3 of title 19, C.R.S. If the minor is less than sixteen years of age 
or not emancipated, the minor's parents or legal guardian may be informed by the facility 
or physician of the consultation, examination, and treatment. The physician or other health 
care provider shall counsel the minor on the importance of bringing his parents or guardian 
into the minor's confidence about the consultation, examination, or treatment. 

(7) (a) When investigating HIV infection, the state department of public health and 
environment and county, district, and municipal public health agencies, within their 
respective jurisdictions, may inspect and have access to medical and laboratory records 
relevant to the investigation of HIV infection. 

(b) Repealed. 

(7.5) (a) When a public safety worker, emergency medical service provider, or staff 
member of a detention facility has been exposed to blood or other bodily fluid which there 
is a reason to believe may be infectious with HIV, the state department of public health and 
environment and county, district, and municipal public health agencies within their respec- 
tive jurisdictions shall assist in evaluation and treatment of any involved persons by: 

(I) Accessing information on the incident and any persons involved to determine 
whether a potential exposure to HIV occurred; 

(II) Examining and testing such involved persons to determine HIV infection when the 
fact of an exposure has been established by the state department of public health and 
environment or a county, district, or municipal public health agency; 

(III) Communicating relevant information and laboratory test results on the involved 
persons to such persons' attending physicians or directly to the involved persons if the 
confidentiality of such information and test results is acknowledged by the recipients and 
adequately protected, as determined by the state department of public health and environ- 
ment or a county, district, or municipal public health agency; and 

(IV) Providing counseling to the involved persons on the potential health risks and 
treatment resulting from exposure. 

(b) The employer of an exposed person shall ensure that relevant information and 
laboratory test results on the involved person are kept confidential. Such information and 
laboratory results are considered medical information and protected from unauthorized 
disclosure. 

(c) For purposes of this subsection (7.5), "public safety worker" includes, but is not 
hmited to, law enforcement officers, peace officers, and firefighters. 

(8) (a) No health care provider or other person, and no hospital, clinic, laboratory, or 
other private or public institution, shall test, or shall cause by any means to have tested, any 
specimen of any patient for HIV infection without the knowledge and consent of the patient; 
except that knowledge and consent need not be given: 



25-4-1405.5 



Health 



Title 25 - page 240 



(1) Where a health care provider or a custodial employee of the department of 
corrections or the department of human services is exposed to blood or other bodily fluids 
that may be infectious with HIV; 

(II) When a patient's medical condition is such that knowledge and consent cannot be 
obtained; 

(III) When the testing is done as part of seroprevalence surveys if all personal 
identifiers are removed from the specimens prior to the laboratory testing; 

(IV) When the patient to be tested is sentenced to and in the custody of the department 
of corrections or is committed to the Colorado mental health institute at Pueblo and 
confined to the forensic ward or the minimum or maximum security ward of such institute; 

(V) When a person is bound over for trial of a sexual offense as set forth in section 
18-3-415 or 18-3-415.5, C.R.S., or subject to testing under section 18-7-201.5 or 18-7- 
205.5, C.R.S., and is tested by a health care provider or facility other than one that 
exclusively provides HIV testing and counseling; 

(VI) When a pregnant woman is informed of the need for an HIV test and given the 
opportunity to decline the test as specified in section 25-4-201. 

(b) Any patient tested for HIV infection pursuant to this subsection (8) without his 
knowledge and consent shall be given notice promptly, personally, and confidentially that 
a test sample was taken and that the results of such test may be obtained upon his request. 

Source: L. 87: Entire part added, p. 1132, § 1, effective June 8; (6) amended, p. 1589, 
§ 66, effective July 10. L. 88: (8)(a)(V) added, p. 729, § 2, effective July 1. L. 90: IP(3), 
(5), and (8)(a)(I) amended, (7.5) added, and (8)(a)(V) R&RE, pp. 1311, 1312, §§ 5, 6, 
effective May 24. L. 91: (7) amended, p. 996, § 2, effective April 20; (8)(a)(IV) amended, 
p. 1145, § 12, effective May 18. L. 94: IP(3) and (8)(a)(I) amended, pp. 2772, 2702, 
§§ 465, 256, effective July 1. L. 99: (8)(a)(V) amended, p. 1003, § 9, effective May 29. 
L. 2001: IP(7.5)(a) amended and (7.5)(c) added, p. 825, § 2, effective August 8. L. 2009: 
IP(8)(a) amended and (8)(a)(VI) added, (SB 09-179), ch. 1 12, p. 473, § 16, effective April 
9. L. 2010: (1), (2), IP(3), (6), (7)(a), IP(7.5)(a), (7.5)(a)(II), and (7.5)(a)(III) amended, 
(HB 10-1422), ch. 419, p. 2097, § 104, effective August 11. L. 2011: (6) amended, (HB 
11-1303), ch. 264, p. 1165, § 61, effective August 10. 

Editor's note: Subsection (7)(b)(II) provided for the repeal of subsection (7)(b), effective July 1, 
1994. (SeeL. 91, p. 996.) 

Cross references: (1) For HIV testing of applicants for insurance, see § 10-3-1104.5; for HIV 
testing of persons convicted of prostitution or patronizing a prostitute, see §§ 18-7-201.5 and 
18-7-205.5. 

(2) For the legislative declaration contained in the 1994 act amending the introductory portion to 
subsection (3) and subsection (8)(a)(I), see section 1 of chapter 345, Session Laws of Colorado 1994. 
For the legislative declaration contained in the 1999 act amending subsecdon (8)(a)(V), see section 
1 of chapter 254, Session Laws of Colorado 1999. 

ANNOTATION 



Law reviews. For article, "Consent to 
Treatment and Access to Minors' Medical Re- 
cords", see 17 Colo. Law. 1323 (1988). 

FlaintifTs claim for invasion of privacy 
arising out of unauthorized blood testing for 
HIV not precluded by subsection (8)(b). By its 
grant of immunity in certain circumstances, the 
general assembly has recognized that civil ac- 



tions may occur. Further, by granting such im- 
munity in the absence of providing a specific 
civil remedy, the general assembly has not 
evinced any intent to preclude a person from 
bringing a civil action. In the absence of such, 
the common law provides the mechanism for 
enforcing the violation. Doe v. High-Tech Inst., 
Inc., 972 P.2d 1060 (Colo. App. 1998). 



25-4-1405.5. Extraordinary circumstances - procedures. (1) The general assembly 
hereby finds, determines, and declares that the continued risk to the public health of the 
citizens of this state resulting from the presence and transmission of HIV infection warrants 
the implementation of controlled extraordinary measures to further the containment of HIV. 



Title 25 - page 241 Disease Control 25-4-1406 

(2) (a) (I) The provision of confidential counseling and testing services for HIV is the 
preferred screening service for detection of HIV infection. However, the department shall, 
consistent with generally accepted practices for the protection of the public health and 
safety, conduct an anonymous counseling and testing program for persons considered to be 
at high risk for infection with HIV. Such program shall be conducted at selected HIV testing 
sites. The department may operate sites or contract through local boards of health to conduct 
such testing in conjunction with counseling and testing sites, subject to maintaining 
standards for performance set by the state board of health. 

(II) The state board of health shall adopt rules specifying the performance standards for 
anonymous and confidential counseling and testing sites. Standards shall include, but are 
not limited to, performance standards for notifying and counseling HIV-infected persons 
and for partner notification. 

(b) (I) The disclosure of an individual's name, address, phone number, or birth date 
shall not be required under the program as a condition of being tested to determine whether 
such person is infected with HIV. Any provision of this part 14 that requires or can be 
construed to require a person seeking to be tested for HIV to disclose such information shall 
not apply to persons seeking to be tested at said test sites. 

(II) Notwithstanding the provisions of subparagraph (I) of this paragraph (b), the age 
and sex of a person seeking to be tested at the said test sites may be required. A person may 
provide personal identifying information after counseling, if the person volunteers to do so. 

(c) to (e) (Deleted by amendment, L. 93, p. 539, § 1, effective July 1, 1993.) 

(3) and (4) (Deleted by amendment, L. 93, p. 539, § 1, effective July 1, 1993.) 

Source: L. 90: Entire section added, p. 1313, § 9, effective May 24. L. 93: Entire 
section amended, p. 539, § 1, effective July 1. 

25-4-1406. Public health procedures for persons with HIV infection. (1) Orders 
directed to individuals with HIV infection or restrictive measures on individuals with HIV 
infection, as described in this part 14, shall be used as the last resort when other measures 
to protect the public health have failed, including all reasonable efforts, which shall be 
documented, to obtain the voluntary cooperation of the individual who may be subject to 
such an order. The orders and measures shall be applied serially with the least intrusive 
measures used first. The burden of proof shall be on the state department of public health 
and environment or the county, district, or municipal public health agency to show that 
specified grounds exist for the issuance of the orders or restrictive measures and that the 
terms and conditions imposed are no more restrictive than necessary to protect the public 
health. 

(2) When the executive director of the state department of public health and environ- 
ment or the director of the county, district, or municipal public health agency, within his or 
her respective jurisdiction, knows or has reason to believe, because of medical or epide- 
miological information, that a person has HIV infection and is a danger to the public health, 
he or she may issue an order to: 

(a) Require a person to be examined and tested to determine whether he has HIV 
infection; 

(b) Require a person with HIV infection to report to a qualified physician or health 
worker for counseling on the disease and for information on how to avoid infecting others; 

(c) Direct a person with HIV infection to cease and desist from specified conduct which 
endangers the health of others, but only if the executive director or local director has 
determined that clear and convincing evidence exists to believe that such person has been 
ordered to report for counseling or has received counseling by a qualified physician or 
health worker and continues to demonstrate behavior which endangers the health of others. 

(3) If a person violates a cease-and-desist order issued pursuant to paragraph (c) of 
subsection (2) of this section and it is shown that the person is a danger to others, the 
executive director of the state department of public health and environment or the director 
of the county, district, or municipal public health agency may enforce the cease-and-desist 
order by imposing such restrictions upon the person as are necessary to prevent the specific 
conduct which endangers the health of others. Restrictions may include required partici- 



25-4-1407 Health Title 25 - page 242 

pation in evaluative, therapeutic, and counseling programs. Any restriction shall be in 
writing, setting forth the name of the person to be restricted and the initial period of time, 
not to exceed three months, during which the order shall remain effective, the terms of the 
restrictions, and such other conditions as may be necessary to protect the public health. 
Restrictions shall be imposed in the least restrictive manner necessary to protect the public 
health. The executive director or the director issuing an order pursuant to this subsection (3) 
shall review petitions for reconsideration from the person affected by the order. Restriction 
orders issued by directors of county, district, or municipal public health agencies shall be 
submitted for review and approval of the executive director of the state department of public 
health and environment. 

(4) (a) Upon the issuance of any order by the state department of public health and 
environment or the county, district, or municipal public health agency pursuant to subsec- 
tion (2) or (3) of this section, such department or agency shall give notice promptly, 
personally, and confidentially to the person who is the subject of the order stating the 
grounds and provisions of the order and notifying the person who is the subject of the order 
that he or she has a right to refuse to comply with such order and a right to be present at 
a judicial hearing in the district court to review the order and that he or she may have an 
attorney appear on his or her behalf in said hearing. If the person who is the subject of the 
order refuses to comply with such order and refuses to cooperate voluntarily with the 
executive director of the state department of public health and environment or the director 
of the county, district, or municipal public health agency, the executive director or county, 
district, or municipal director may petition the district court for an order of compliance with 
such order. The executive director or county, district, or municipal director shall request the 
district attorney to file such petition in the district court, but, if the district attorney refuses 
to act, the executive director or county, district, or municipal director may file such petition 
and be represented by the attorney general. If an order of compliance is requested, the court 
shall hear the matter within ten days after the request. Notice of the place, date, and time 
of the court hearing shall be made by personal service or, if the person is not available, shall 
be mailed to the person who is the subject of the order by prepaid certified mail, return 
receipt requested, at his or her last-known address. Proof of mailing by the state department 
of public health and environment or the county, district, or municipal public health agency 
shall be sufficient notice under this section. The burden of proof shall be on the state 
department of public health and environment or the county, district, or municipal public 
health agency to show by clear and convincing evidence that the specified grounds exist for 
the issuance of the order and for the need for compliance and that the terms and conditions 
imposed therein are no more restrictive than necessary to protect the public health. Upon 
conclusion of the hearing, the court shall issue appropriate orders affirming, modifying, or 
dismissing the order. 

(b) If the executive director or the director of a county, district, or municipal public 
health agency does not petition the district court for an order of compliance within thirty 
days after the person who is the subject of the order refuses to comply, such person may 
petition the court for dismissal of the order. If the district court dismisses the order, the fact 
that such order was issued shall be expunged from the records of the state department of 
public health and environment or the county, district, or municipal public health agency. 

(5) Any hearing conducted pursuant to this section shall be closed and confidential, and 
any transcripts or records relating thereto shall also be confidential. 

Source: L. 87: Entire part added, p. 1133, § 1, effective June 8. L. 90: (2)(c) and (3) 
amended, p. 1312, § 7, effective May 24. L. 94: (1), IP(2), (3), and (4) amended, p. 2772, 
§ 466, effective July 1. L. 2010: (1), IP(2), (3), and (4) amended, (HB 10-1422), ch. 419, 
p. 2098, § 105, effective August 11. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(1), the introductory portion to subsection (2), and subsections (3) and (4), see section 1 of chapter 
345, Session Laws of Colorado 1994. 

25-4-1407. Emergency public health procedures. (1) When the procedures of 
section 25-4-1406 have been exhausted or cannot be satisfied as a result of threatened 



Title 25 - page 243 Disease Control 25-4-1408.5 

criminal behavior and the executive director of the state department of public health and 
environment or the director of a county, district, or municipal public health agency, within 
his or her respective jurisdiction, knows or has reason to believe, because of medical 
information, that a person has HIV infection and that such person presents an imminent 
danger to the public health, the executive director or the director of a county, district, or 
municipal public health agency may bring an action in district court, pursuant to rule 65 of 
the Colorado rules of civil procedure, to enjoin such person from engaging in or continuing 
to engage in specific conduct which endangers the public health. The executive director or 
county, district, or municipal director shall request the district attorney to file such action in 
the district court, but, if the district attorney refuses to act, the executive director or county 
or district director may file such action and be represented by the attorney general. 

(2) Under the circumstances outlined in subsection (1) of this section, in addition to the 
injunction order, the district court may issue other appropriate court orders including, but 
not limited to, an order to take such person into custody, for a period not to exceed 
seventy-two hours, and place him in a facility designated or approved by the executive 
director. A custody order issued for the purpose of counseling and testing to determine 
whether such person has HIV infection shall provide for the immediate release from 
custody and from the facility of any person who tests negative and may provide for 
counseling or other appropriate measures to be imposed on any person who tests positive. 
The person who is the subject of the order shall be given notice of the order promptly, 
personally, and confidentially stating the grounds and provisions of the order and notifying 
such person that he has a right to refuse to comply with such order and a right to be present 
at a hearing to review the order and that he may have an attorney appear on his behalf in 
said hearing. If such person contests testing or treatment, no invasive medical procedures 
shall be carried out prior to a hearing being held pursuant to subsection (3) of this section. 

(3) Any order issued by the district court pursuant to subsection (2) of this section shall 
be subject to review in a court hearing. Notice of the place, date, and time of the court 
hearing shall be given promptly, personally, and confidentially to the person who is the 
subject of the court order. Such hearing shall be conducted by the court no later than 
forty-eight hours after the issuance of the order. Such person has a right to be present at the 
hearing and may have an attorney appear on his behalf in said hearing. Upon conclusion of 
the hearing, the court shall issue appropriate orders affirming, modifying, or dismissing the 
order. 

(4) The burden of proof shall be on the state or the county, district, or municipal public 
health agency to show by clear and convincing evidence that grounds exist for the issuance 
of any court order pursuant to subsection (1) or (2) of this section. 

(5) Any hearing conducted by the district court pursuant to subsection (1) or (2) of this 
section shall be closed and confidential, and any transcripts or records relating thereto shall 
also be confidential. 

(6) Any order entered by the district court pursuant to subsection (1) or (2) of this 
section shall impose terms and conditions no more restrictive than necessary to protect the 
public health. 

Source: L. 87: Entire part added, p. 1135, § 1, effective June 8. L. 94: (1) amended, p. 
2774, § 467, effective July 1. L. 2010: (1) and (4) amended, (HB 10-1422), ch. 419, p. 
2100, § 106, effective August 11. 

Cross references: For the legislafive declaration contained in the 1994 act amending subsection 
(1), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-1408. Rules and regulations. The state board of health may adopt such rules and 
regulations as are in its judgment necessary to carry out the provisions of this part 14. 

Source: L. 87: Entire part added, p. 1136, § 1, effective June 8. 

25-4-1408.5. Eligibility for services. Notwithstanding any other provision of this part 
14 to the contrary, programs and services that provide for the investigation, identification, 



25-4- 1 409 Health Title 25 - page 244 

testing, preventive care, or treatment of HIV infection or AIDS shall be available to a person 
regardless of his or her race, religion, gender, ethnicity, national origin, or immigration 
status. 

Source: L. 2006, 1st Ex. Sess.: Entire section added, p. 27, § 6, effective July 31. 

ANNOTATION 

Law reviews. For article, "2006 Immigration 
Legislation in Colorado", see 35 Colo. Law. 79 
(October 2006). 

25-4-1409. Penalties. (1) Any attending physician or other health care provider 
required to make a report pursuant to section 25-4-1402 or any laboratory or person 
required to make a report pursuant to section 25-4-1403 who fails to make such a report 
commits a class 2 petty offense and, upon conviction thereof, shall be punished by a fine 
of not more than three hundred dollars. 

(2) Any physician or other health care provider, any officer or employee of the state 
department of public health and environment or a county, district, or municipal public 
health agency, or any person, firm, or corporation that violates section 25-4-1404 by 
releasing or making public confidential public health reports or by otherwise breaching the 
confidentiality requirements of said section is guilty of a misdemeanor and, upon conviction 
thereof, shall be punished by a fine of not less than five hundred dollars nor more than five 
thousand dollars, or by imprisonment in the county jail for not less than six months nor 
more than twenty-four months, or by both such fine and imprisonment. 

Source: L. 87: Entire part added, p. 1136, § 1, effective June 8. L. 90: Entire section 
amended, p. 1312, § 8, effective May 24. L. 94: (2) amended, p. 2774, § 468, effective 
July 1. L. 2010: (2) amended, (HB 10-1422), ch. 419, p. 2100, § 107, effective August 11. 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(2), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-1410. Repeal of part. (Repealed) 

Source: L. 87: Entire part added, p. 1137, § 1, effective June 8. L. 90: Entire section 
repealed, p. 1314, § 10 effective May 24. 

25-4-1411. AIDS drug assistance program - legislative declaration - no entitlement 
created. ( 1 ) (a) The general assembly recognizes that medical science is making strides 
in treating persons who have AIDS or HIV. The general assembly recognizes that new 
pharmaceutical products have been developed that delay the debilitating effects of AIDS 
and HIV, thereby allowing HIV-infected persons to maintain a higher quality of life and 
remain productive. The general assembly also recognizes that many persons with AIDS may 
eventually have their medical bills paid through some form of government assistance. The 
general assembly finds that the state will recognize a savings in medical assistance if 
persons with HIV can remain working longer. 

(b) Therefore, the general assembly declares that the purpose of this section is to 
implement the drug treatment component of the federal "Ryan White C.A.R.E. Act of 
1990", as amended, by creating the AIDS drug assistance program to provide certain 
pharmaceutical products to qualifying low-income persons who have AIDS or HIV. 

(c) Nothing in this section shall be construed to establish any entitlement to services 
from the department of public health and environment. 

(2) Subject to available appropriations, the department of public health and environ- 
ment is authorized to implement and administer an AIDS drug assistance program, referred 
to in this section as the "state program", to provide pharmaceutical products to treat HIV 



Title 25 - page 245 Disease Control 25-4-1411 

disease or prevent the serious deterioration of health arising from HIV disease in eligible 
individuals. The general assembly may annually appropriate moneys from the general fund 
to purchase pharmaceutical products for persons participating in the state program. The 
state program shall also be funded with federal funds available under the federal "Ryan 
White C.A.R.E. Act of 1990", as amended, and moneys appropriated for the implementa- 
tion and administration of the state program from the AIDS and HIV prevention fund as 
authorized by section 25-4-1415 (1). 

(3) To be eligible to participate in the state program, an individual shall: 

(a) Have a medical diagnosis of HIV disease; 

(b) (Deleted by amendment, L. 2001, p. 332, § 1, effective July 1, 2001.) 

(c) Have a prescription from an authorized provider for a pharmaceutical product or 
combination of pharmaceutical products that are included on the drug formulary for the 
state program; 

(d) Meet income eligibility requirements as determined by the department of public 
health and environment in consultation with the subcommittee of the advisory group on 
AIDS policy established in subsection (4) of this section. 

(3.5) Notwithstanding any other provision of this part 14 to the contrary, if a person 
meets the eligibility requirements set forth in subsection (3) of this section, he or she shall 
be eligible for programs and services that provide for the investigation, identification, 
testing, preventive care, or treatment of HIV infection or AIDS regardless of his or her race, 
religion, gender, ethnicity, national origin, or immigration status. 

(4) A subcommittee of an advisory group convened by the governor to make recom- 
mendations for AIDS policy in the state shall serve in an advisory role to the department of 
public health and environment in implementing the state program and shall advise and 
recommend to the department of public health and environment what pharmaceutical 
products should be listed on the drug formulary for the state program. 

(5) If at any time the department of public health and environment, in consultation with 
the subcommittee of the advisory group on AIDS policy established in subsection (4) of this 
section, determines that the AIDS drug assistance program is reaching the program's fiscal 
limitations, the department, in consultation with the subcommittee, shall implement a policy 
of giving preference to applicants of lower income, who otherwise meet the eligibility 
requirements in subsection (3) of this section, for enrollment into the program. 

(6) (a) Except as otherwise provided in section 24-75-1104.5 (5), C.R.S., beginning in 
the 2004-05 fiscal year, and for each fiscal year thereafter so long as the state receives 
moneys pursuant to the master settlement agreement, the general assembly shall appropriate 
to the department of public health and environment for the state program the amount of 
moneys to be received by the state program pursuant to section 24-75-1 104.5 (1) (j), C.R.S. 
The general assembly shall appropriate the amount specified in this subsection (6) from 
moneys credited to the tobacco litigation settlement cash fund created in section 24-22-1 15, 
C.R.S. 

(b) The department of public health and environment and the advisory group shall 
determine how the moneys appropriated for the state program pursuant to this subsection 
(6) are to be used. 

Source: L. 98: Entire section added, p. 181, § 1, effective August 5. L. 2001: (3) 
amended and (5) added, p. 332, § 1, effective July 1. L. 2004: (6) added, p. 1710, § 8, 
effective June 4. L. 2006, 1st Ex. Sess.: (3.5) added, p. 27, § 7, effective July 31. L. 2009: 
(6)(a) amended, (SB 09-210), ch. 124, p. 531, § 3, effective April 16; (2) and (6)(a) 
amended, (SB 09-269), ch. 333, p. 1766, § 5, effective June 1. 

Editor's note: Amendments to subsecfion (6)(a) by Senate Bill 09-269 and Senate Bill 09-210 
were harmonized. 

Cross references: For the "Ryan White C.A.R.E. Act of 1990", see Pub.L. 101-381, codified at 42 
U.S.C. sec. 300ff et seq. 



25-4-1412 Health Title 25 - page 246 

ANNOTATION 

Law reviews. For article, "2006 Immigration 
Legislation in Colorado", see 35 Colo. Law. 79 
(October 2006). 

25-4-1412. Definitions. As used in this section and sections 25-4-1413 to 25-4-1415, 
unless the context otherwise requires: 

(1) "Program" means the Colorado HIV and AIDS prevention grant program created 
in section 25-4-1413. 

(2) "State board" means the state board of health created in section 25-1-103. 

Source: L. 2006: Entire section added, p. 1755, § 1, effective June 6. 

25-4-1413. Program. (1) There is hereby created in the department the Colorado 
HIV and AIDS prevention grant program to address local community needs in the areas of 
medically accurate HIV and AIDS prevention and education through a competitive grant 
process. The department shall administer the program. 

(2) Grant applicants shall be nonprofit organizations that are governed by a board of 
directors, have the benefit of tax-exempt status pursuant to section 501 (c) (3) of the federal 
"Internal Revenue Code of 1986" or are county, district, or municipal public health 
agencies. 

(3) (a) Preference shall be given to grant applicants that have as one of their primary 
purposes HIV and AIDS prevention and education. 

(b) Grants may be given to organizations that conduct HIV prevention in conjunction 
with other co-morbidities secondary to HIV infections. 

(4) Grant applications shall include, but need not be limited to: 

(a) A statement of the local HIV and AIDS prevention or education issue to be 
addressed, a description of the constituency that shall be served or targeted, and how the 
constituency will benefit; 

(b) A description of the goals and objectives of the grant applicant in submitting an 
application under the program; and 

(c) A description of the activities planned to accomplish the goals and objectives of the 
grant applicant and of the outcome measures that will be used by the grant applicant. 

(5) Grants shall only be given for medically accurate HIV and AIDS prevention and 
education programs that are based in behavioral and social science theory and research and 
shall not be used to contribute to existing scholarships, directly to endowments, fund-raising 
events, annual fund drives, or debt reduction. 

Source: L. 2006: Entire section added, p. 1755, § 1, effective June 6. L. 2007: (2) 

amended, p. 2041, § 67, effective June 1. L. 2010: (2) amended, (HB 10-1422), ch. 419, 
p. 2100, § 108, effective August 11. 

25-4-1414. Grant program - conflict of interest. (1) (a) The program shall fund 
medically accurate HIV and AIDS prevention and education programs through a compet- 
itive grant process that shall be overseen by the HIV and AIDS prevention grant program 
advisory committee, which is hereby created and referred to in this section as the "advisory 
committee". The advisory committee shall consist of seven members appointed by the 
executive director of the department as follows: 

(I) (Deleted by amendment, L. 2009, (SB 09-179), ch. 1 12, p. 474, § 17, effective April 
9, 2009.) 

(II) One member who is recommended by the department's minority health advisory 
commission; 

(III) Four members who are recommended by a statewide collaborative group that 
assists the department in the department's comprehensive plan for HIV and AIDS preven- 
tion; 



Title 25 - page 247 Disease Control 25-4-1415 

(IV) One member who has expertise in HIV and AIDS prevention and education; and 

(V) One member who represents a clinic that receives moneys under part 3 of the 
federal "Ryan White C.A.R.E. Act of 1990", as amended. 

(b) The composition of the advisory committee shall reflect, to the extent practical, 
Colorado's ethnic, racial, and geographic diversity. 

(c) The grants administered pursuant to section 25-4-1413 shall only be subject to the 
restrictions provided for in this section and section 25-4-1413 and shall not be subject to the 
same restrictions as grants provided with federal moneys for HIV and AIDS prevention. The 
state board, upon recommendations of the advisory committee, shall adopt rules that 
specify, but need not be limited to, the following: 

(1) The procedures and timelines by which an entity may apply for program grants; 

(II) Grant application contents, in addition to those specified in section 25-4-1413 (3); 

(III) Criteria for selecting the entities that shall receive grants and determining the 
amount and duration of the grants; 

(IV) Reporting requirements for entities that receive grants pursuant to this section; and 

(V) The quahfications of an adequate proposal. 

(2) The advisory committee shall review the applications received pursuant to this 
section and submit to the state board and the executive director of the department 
recommended grant recipients, recommended grant amounts, and the duration of each 
recommended grant. In making recommendations for grants, the advisory committee shall 
consider the distribution of federal funds in the areas of HIV and AIDS prevention, 
education, and treatment. Within thirty days after receiving the advisory committee's 
recommendations, the executive director shall submit his or her recommendations to the 
state board. The state board shall have the final authority to approve the grants administered 
under this section and section 25-4-1413. If the state board disapproves a recommendation 
for a grant recipient, the advisory committee may submit a replacement recommendation 
within thirty days after disapproval. In making grant recommendations, the advisory 
committee shall follow the purpose of the program as outlined in section 25-4-1413. The 
state board shall award grants to the entities selected by the advisory committee, specifying 
the amount and duration of each grant award. In reviewing and approving grant applica- 
tions, the advisory committee and the state board shall ensure that grants are distributed 
statewide and address the needs of both urban and rural residents of Colorado. 

(3) If a member of the advisory committee has an immediate personal, private, or 
financial interest in any matter pending before the advisory committee, the member shall 
disclose the fact and shall not vote upon the matter. 

Source: L. 2006: Entire section added, p. 1756, § 1, effective June 6. L. 2009: 
(l)(a)(I), (l)(a)(III), and (l)(a)(V) amended, (SB 09-179), ch. 112, p. 474, § 17, effective 
April 9. 

Cross references: For the "Ryan White C.A.R.E. Act of 1990", see Pub.L. 101-381, codified at 42 
U.S.C. sec. 300ff et seq. 

25-4-1415. Cash fund - administration - limitation. (1) There is hereby created in 
the state treasury the AIDS and HIV prevention fund, referred to in this section as the 
"fund", that shall consist of moneys that may be appropriated to the fund by the general 
assembly. The moneys in the fund shall be subject to annual appropriation by the general 
assembly for the direct and indirect costs associated with the implementation of the 
program; except that, for the 2009-10 and 2010-11 fiscal years, the general assembly may 
appropriate moneys from the fund to the department of public health and environment for 
the implementation and administration of the AIDS drug assistance program described in 
section 25-4-141 1 (2). Any moneys in the fund not expended for the purpose of the program 
may be invested by the state treasurer as provided by law. All interest and income derived 
from the investment and deposit of moneys in the fund shall be credited to the fund. Any 
unexpended and unencumbered moneys remaining in the fund at the end of a fiscal year 
shall remain in the fund and shall not be credited or transferred to the general fund or 
another fund. 



25-4-1501 Health Title 25 - page 248 

(2) Pursuant to section 24-75-1 104.5 (1) (m), C.R.S., and except as otherwise provided 
in section 24-75-1104.5 (5), C.R.S., beginning in the 2006-07 fiscal year and in each fiscal 
year thereafter so long as the state receives moneys pursuant to the master settlement 
agreement, the state treasurer shall annually transfer to the fund two percent, not to exceed 
two million dollars in any fiscal year, of the total amount of the moneys received by the state 
pursuant to the master settlement agreement, not including attorney fees and costs, during 
the preceding fiscal year. The state treasurer shall transfer the amount specified in this 
subsection (2) from moneys credited to the tobacco litigation settlement cash fund created 
in section 24-22-115, C.R.S. 

(3) The department may receive up to five percent of the moneys annually appropriated 
by the general assembly to the department from the fund created in subsection ( 1 ) of this 
section for the actual costs incurred in administering the program. 

(4) For the 2009-10 fiscal year, the state treasurer shall transfer from the fund: 

(a) To the Colorado health service corps fund created in section 25-20.5-706 the 
amount of one hundred twenty thousand dollars; and 

(b) To the visa waiver program fund created in section 25-20.5-605 the amount of 
sixty-seven thousand two hundred ninety-four dollars for appropriation by the general 
assembly to the primary care office in the prevention services division of the department. 

Source: L. 2006: (2) amended, p. 1042, § 14, effective May 25; entire section added, p. 
1757, § 1, effective June 6. L. 2009: (1) and (2) amended, (SB 09-269), ch. 333, p. 1767, 
§ 6, effective June 1; (4) added, (HB 09-1111), ch. 396, p. 2142, § 7, effective June 2. 
L. 2010: (1) amended, (HB 10-1323), ch. 35, p. 131, § 6, effective March 22; (4)(a) 
amended, (HB 10-1138), ch. 142, p. 484, § 8, effective July 1. 

PART 15 

BREAST CANCER SCREENING 

Cross references: For provisions relating to mandatory insurance coverage for mammography 

screening, see § 10-16-104 (4). 

25-4-1501. Legislative declaration. The general assembly hereby finds and declares 
that the incidence of breast cancer in women of this state is a significant health problem that 
can and should be reduced through early detection and treatment. Accordingly, it is the 
intention of the general assembly in enacting this part 15 to provide breast cancer screening 
where it is not otherwise readily available for reasons of cost or distance to suitable medical 
facihties. 

Source: L. 88: Entire part added, p. 1013, § 1, effective April 7. 

25-4-1502. Definitions. As used in this part 15, unless the context otherwise requires: 

(1) (Deleted by amendment, L. 95, p. 487, § 2, effective July 1, 1995.) 

(2) "Board" means the state board of health. 

(3) "Department" means the department of public health and environment. 

(3.5) "Diagnostic screening" means the use of procedures including physical exami- 
nations, radiologic imaging, surgical techniques, and any new technologies approved by the 
board for detecting whether abnormalities of the breast are malignant or benign. 

(4) "Fund" means the breast cancer screening fund established in section 25-4-1503. 

(5) "Screening" means the conduct of physical examinations, visual inspections, or 
other medical tests exclusively for the purpose of ascertaining the existence of any 
physiological abnormahty which might be indicative of the presence of disease. "Screen- 
ing" includes diagnostic screening services. 

Source: L. 88: Entire part added, p. 1013, § 1, effective April 7. L. 94: (3) amended, 
p. 2775, § 469, effective July 1. L. 95: (1) and (5) amended and (3.5) added, p. 487, § 2, 
effective July 1 . 



Title 25 - page 249 Disease Control 25-4-1505 

Cross references: For the legislative declaration contained in the 1994 act amending subsection 
(3), see section 1 of chapter 345, Session Laws of Colorado 1994. 

25-4-1503. Fund created. (1) There is hereby established in the state treasury a fund 
to be known as the breast cancer screening fund, which shall be subject to annual 
appropriation to the department for the purposes of this part 15. The fund shall be credited 
with such appropriations as the general assembly may make from the general fund for the 
purposes of this part 15, as well as any moneys received by the department pursuant to 
section 25-4-1505 (2) and (4). In accordance with section 24-36-114, C.R.S., all interest 
derived from the deposit and investment of this fund shall be credited to the general fund. 

(2) All moneys credited to the breast cancer screening fund which are not expended 
during the fiscal year shall be retained in the fund for its future use and shall not be credited 
or transferred to the general fund or any other fund. 

Source: L. 88: Entire part added, p. 1014, § 1, effective April 7. L. 92: Entire section 
amended, p. 1296, § 1, effective May 29. 

25-4-1504. Allocation of fund. (1) All moneys in the fund shall be used by the 
department for the following purposes: 

(a) The creation and development of a breast cancer screening program, undertaken by 
private contract for services or operated by the department, that will improve the availability 
of breast cancer screening and which may include the purchase, maintenance, and staffing 
of a truck, a van, or any other vehicle suitably equipped to perform breast cancer screening; 

(a.5) To provide such further breast cancer diagnostic screening services, as may be 
indicated; 

(b) The creation and operation of a referral service for the benefit of women for whom 
furt